Previous studies have shown that women not only donate live-related and unrelated kidneys more often, but are also less likely to receive a live kidney than men. Few data are, however, available from developing countries. To study a possible gender imbalance in living donor (LD) renal transplantation in India, we retrospectively analyzed all LD renal transplantations performed at a single center between 2001 and 2005. Of the 682 recipients, 606 (88.9%) were males and 76 (11.1%) were females (P<.0001). There were 552 biologically related, 118 spousal, and 12 unrelated nonspousal donors. Among the donors, there were 451 (66.1%) females and 231 (33.9%) males (P<.001). Most of the live donations were contributed by mothers (32.1%). In the spousal group, the greatest gender disparity was observed with predominantly wives donating for their husbands (90.7% vs 9.3%). Complex social and economic factors are responsible for the overall gender imbalance. In conclusion, women represent a highly vulnerable group in LD renal transplantation. Awareness and changes in attitudes of the public as well as physicians are needed to eliminate this gender inequity.