*Purpose: New and coming information about the risk of living kidney donors make the effort to study very carefully the option of living kidney donor transplantation (LKDT) as the optimal therapy for many patients with end-stage renal disease. A significant percentage of such transplants are not accomplished for both medical and nonmedical reasons related to donors and recipients. However, the impact of these discard in a transplant program was not well identified. The objective of this study is to clarify key reasons for exclusion of LDKT, and the consequences for the candidates for undergoing transplantation.

*Methods: 781 donor-recipient couples were evaluated in our hospital (January/2005-December/2013), following the recommendations from the international guidelines for the exclusion of potential LKD. The consequences of discards in transplant candidates were analyze in cases of 2012 and 2013, and follow till October of 2018. The study was approved by the Local Ethical Committee.

*Results: 402 (51.5%) successfully donated, and 379 (48.5%) were excluded. Donor and candidates discarded were older at the evaluation (55.07 ± 12.14 vs 51.73 ± 10.93 years, p<0.001; 48.81 ± 14.05 vs 44.62 ± 13.91 years, p<0.001). Female donor was more prevalent in discard and transplant groups (68.3% / 65.9%), and male in patients in both groups (59.9% / 61.7%) with no significant association (p=0.44 ; p=0.53). Donor-recipient relation more frequent in discard group were married couple, siblings and mothers (38.7%, 23.7%, 20.8%). Genetically relation between donor and recipient was lower in discard group (52.8% / 60.7%, p=0.03). The most frequent reason for kidney discard was donor pathology (47.5%; low eGFR, diabetes, impaired glucose tolerance, hypertension, cardiovascular and tumoral pathology during study, and proteinuria), followed by uncumplying positive cross-match criteria for desensitization (14.7%), negative of the donor (9.7%), decease donor kidney transplant (DDKT, 8%), and pathology in recipients during study (7.2%). 60.1% of discarded couples could be ruled out for transplantation with our basic protocol, minimizing sanitary costs. In transplant group, recipient survival rate was 98%, graft survival of 97.26 %, and free- acute rejection of 90%. Of the discarded candidates in the period 2012-2013 (n = 106), 36.8% received a DDKT, 17% a LDKT with another donor, and 7.5% were keeping on waiting list, but 18.9% were exitus, 3.8% excluded from the waiting list, and 14.2% lost of follow-up.

*Conclusions: Evaluation of living donor for kidney transplantation is necessary to guarantee its health and the successful of the transplant. In most cases, the transplants were not undertaken due to donor pathology. 53% of the discards were undergoing to transplant, with a 31.4% probability to receive an organ from another living donor in the transplanted discard group.

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