*Purpose: Living kidney donation is widely accepted to be a safe procedure. In the absence of reliable predictors of renal dysfunction in potential living kidney donors, the decisions regarding suitability for donation vary from center to center. There is a relative paucity of available information regarding the reasons for potential living kidney donor candidates to be declined. We examined the reasons that potential living donor kidney candidates were declined at our center.

*Methods: Out of 468 referrals for living kidney donation at our center over a nearly 3-year period (January 1, 2017-December 1, 2019), data available for 196 patients who were declined as candidates was examined. The reasons for donors being declined were determined.

*Results: Of the 196 potential living kidney donor candidates who were declined at our center with data available for review, 17.8% were male. The majority of patients were declined for obesity with body mass index (BMI) exceeding the threshold (BMI> 35) at our center. The median BMI of candidates who were turned down was 40.93 (range 35.4-63.9). Median age of candidates who were declined was 37 years. Other reasons for candidates being declined included hypertension (more than one agent), multiple episodes of bilateral kidney stones, documented coronary artery disease, history of gestational diabetes.

*Conclusions: Living kidney donation remains a safe procedure with excellent long-term functional outcomes for the donor. The reasons for candidates to be declined vary from center to center. At our center, the most likely reason for decline was obesity followed by hypertension requiring multiple agents for control. Other reasons included a history of kidney stones, gestational diabetes. Future studies examining a multi-center cohort would better elucidate the most common reasons for donors to be declined across a broad spectrum of candidates. It is not unheard of for donors who have been declined at one center to be accepted for donation at another center.

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