An analysis of the UNOS database suggests a practice pattern that uses live minor kidney donors in clinical circumstances not endorsed by the recommendations of a recent consensus conference on live organ donation. These data reveal that minor donor kidneys were transplanted more frequently to adult than to pediatric recipients, that only 12% of all recipients were identical twins, and that the use of a minor donor provided no better outcome than that expected from an adult donor. Live organ donation from a minor should only be considered when there is no other living donor available and all other opportunities for transplantation have been exhausted.