Living donation is a common procedure in the United States. Substantial variation exists among transplant centers in their protocols and exclusion criteria for potential living donors. In the absence of clinical trial data to guide decisions about exclusion criteria, knowledge of current practices is an important first step in guiding the formulation of donor protocols as well as future studies. Certain trends in live donation practices have become apparent from surveys of transplant programs over the past few decades. Over the past 25 years, opposition in the US to living unrelated donation has gone from strong to essentially nonexistent. With respect to donor age, programs have become less strict regarding upper age limits, but stricter regarding younger donor candidates. Protocols regarding kidney function, blood pressure and diabetes screening also continue to evolve. Although donor follow up is mandated by the OPTN for two years after donation, a majority of donors are lost to follow up by one year. The most commonly cited barriers to donor follow up include donor inconvenience, cost issues including reimbursement to care providers, as well as direct and indirect costs to donors. Here, we review the current knowledge about living donor practices in the U.S.