*Purpose: The key question in living kidney donor assessment is how best to determine the contribution of each kidney to overall renal function as a guide to selection of which kidney to donate. This study aimed to determine the effect of using kidney length to decide which kidney to donate in a retrospective cohort of potential donors.

*Methods: All 333 potential living kidney donors between January 2009 and August 2018 who completed assessment as per UK guidelines in our centre were evaluated. Data included age, sex, kidney length, glomerular filtration rate, split function and renal vascular anatomy. There were 48 exclusions due to inadequate data or incomplete investigations. Statistical analysis was performed using Excel pivot tables and GraphPad Prism.

*Results: Of 285 potential donors included in the study, there were 144 males (mean age 49.9±14.75) and 141 females (mean age 51.2±11.23). Overall the Pearson’s correlation between differences in length and divided function of kidney pairs was 0.1630, p = 0.0058. Of 73 with significant difference (>10%) in divided function, 18 (24.7%) had no difference in kidney length; 54 (74%) had a difference of <2cm and only one of >2cm. Using a difference of 2cm as cut off for performing split function would lead to false reassurance in 72 patients (6 had >20% difference in divided function whereas 66 had 10-20% difference).

*Conclusions: Length difference between kidney pairs alone is not sufficient to replace measurement of divided function; further studies such as a randomised controlled trial are required to resolve it.

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