EDITORIAL COMMENT The authors have evaluated the risk of progression to end-stage renal disease (ESRD) after kidney donation in 4.933.314 healthy participants from 7 cohorts and 52.998 living kidney donors. The 15-year observed risk of ESRD after donation was 3.5 to 5.5 times higher in the kidney donors group. The projected 15-year risk (in the absence of donation) for the average black male donor candidates was 0.21% and the observed risk (after donation) was 0.96%. The risks among black women were 0.12% and 0.59%; the risks among white men were 0.07% and 0.34%, respectively, and the risks among white women were 0.04% and 0.15%, respectively. Risk projection were higher in the presence of lower estimated glomerular filtration rate (GFR) (adjusted hazard ratio for GFR The online risk tool developed by the authors can be used to evaluate, counsel, and accept living kidney-donor candidates (www.transplantmodels.com/esrdrisk).