Therapeutic living kidney donation (TLKD), in which a nephrectomy is performed as definitive treatment for a donor condition, remains uncommon. This multicenter study reports outcomes of seven patients from three centers with symptomatic nutcracker syndrome (NCS) who underwent TLKD through kidney paired exchange between 2022-2024. Among the seven donors, the majority were female (n = 6). Median age was 38 y (range: 23–55 y), and median BMI was 22.9 (range: 19.0–32.6). Nephrectomies were performed via laparoscopic (n = 2), laparoscopic hand-assisted (n = 4), or open (n = 1) technique.