Introduction: The continuing scarcity of organs for transplantation coupled with advances in technology and changes in the legislative framework in the UK have encouraged more opportunity and choice in the options for living donor kidney transplantation. We reviewed the experience of altruistic non-directed kidney donors (ANDKD) at our centre to determine useful ways of optimizing the service while increasing the numbers of donors.
Materials and Methods: All enquiries by potential ANDKD at our centre from October 2007 to September 2017 were analysed. Donor assessment and preparation for donation were performed as per UK Guidelines and local protocol, including mental health and local independent assessment, prior to obtaining Human Tissue Authority approval. 185 enquiries resulted in 50 donations. Forty nine donors underwent hand-assisted laparoscopic donor nephrectomy while one had open nephrectomy. The ANDKD were sent questionnaires and the responses were analysed. The outcome of donation and reasons why the remaining did not proceed to donation were analysed. 
Results and Discussion: During the period, 50 of the 185 enquiries (27%) resulted in kidney donation. There were 27 female donors and 23 males with an overall age range of 22 – 82 years (mean 58). Only 35 of 50 questionnaires (70%) were returned. Two donors had died of causes unrelated to kidney donation. Of the 35 responses, 23(66%) donors were retired, 5 (14%) self-employed and 7 (20%) were employed at the time of donation. Most donors heard about altruistic donation through media (43%) and internet services (31%). Five patients underwent both psychological and psychiatric assessments whereas 28 had psychological and two had psychiatric assessment alone. Twenty four donors (68.6%)  thought psychological or psychiatric assessment was necessary while 11 (31.4%) thought it was not. Thirty three of 35(94%) found the information provided prior to donation adequate and 80% (28/35) rated their experience of the process as good/excellent. A significant proportion felt the process could have been more streamlined and quicker. Attitude towards ANDKD were changed negatively in 3 (8.6%) patients after donation but 88.6% (31/35) donors would recommend kidney donation to others. Thirty six of the donated kidneys were sent to recipients identified by the national Transplant office whereas 14 were fed into the paired/pooled kidney exchange program.
Conclusions: A significant proportion of enquiries for altruistic donation would result in donation. Psychiatric evaluation should be reserved for cases were clinically indicated.  The process needs to be optimized to make the assessment process quicker.