We reviewed the operative complications in 333 living related donor nephrectomies done at our institution over the past 12 years. The overall complication rate was 17.1%; only three patients (0.9%) had major complications, and none died. The major complications were a delayed splenectomy because of bleeding, an adrenalectomy, and acute renal failure in one patient in the immediate postoperative period. We concluded that donor nephrectomy done through a flank incision results in minimal morbidity. © 1994 Southern Medical Association.