Expansion of living kidney donation is needed to meet the increasing global need for kidney replacement therapy. Advances in the understanding of postdonation health outcomes have confirmed that living donation in carefully selected donors is associated with a low absolute risk of kidney failure of 50 per 10,000 after 20 years. However, information about lifetime risks, heterogeneity of risk, and the long-term safety of donors with chronic kidney disease risk factors before or after donation remains incomplete.