Body mass index (BMI) has long been used to screen and evaluate candidates interested in living kidney donation. This narrative review aimed to compare the use of BMI and measures of body composition on outcomes in adults undergoing living kidney donation. A literature search was completed using a combination of Medical Subject Headings (MeSH) terms and key words including living donors, body composition, and BMI. Based on the articles reviewed, increased visceral adiposity was associated with surgical wound complications, whereas BMI was not.