This article is intended to help mental health clinicians who work with kidney transplant teams enhance their understanding, abilities and skills to determine the best possible psychosocially stable living donor candidates who present for evaluation. Additionally, this article is intended to help the clinician gain a better understanding of the donor ability and willingness to give informed consent, and determine those who present for donorship which may be at high risk due to either historic or current mental health, substance use and current lifestyle issues. Finally, this article considers the rationale and goals of pretransplant psychosocial evaluation of potential kidney donors as well as the net effects on the families. The intent is to provide a clinical protocol useful in both private and public hospitals. The current protocol is currently being used at HCA: Henrico Doctors' Hospital, Virginia Transplant Center in Richmond, Virginia. Early post-transplant psychosocial problems and their management and the long-term adaptation for the donors are discussed. Additionally, ethical considerations are addressed.