We read with great interest the meta-analysis by van de Laar et al1 who report that living kidney donors' quality of life was significantly better than that of the general population and healthy controls. While these findings are valuable, we believe that quality of life questionnaires alone may not fully reflect the psychological complexity of living donation. In a recent systematic review, we showed that qualitative studies often reveal a more complex experience for donors,2,3 combining both positive aspects and good quality of life with negative ones (vulnerability, ambivalence, anxiety, and changes in the relationship with the recipient).