Abstract： Objective To investigate the selection and safety of living kidney transplantation in elder donors or with potential medical risks. Methods A retrospective analysis of 66 living kidney donors in our hospital was performed. The donors were stratified into aged below 50 years group (n=42) and aged 50 years or above group (n=24) based on their age, and also into potential-risk group (group A, n=12) and non-risk group (group B, n=54) based on pre-operative evaluation. The length of hospital stay, pre- and post-operative glomerular filtration rate (GFR), serum creatinine (Scr) and complications were compared among the donors. Results The pre-operative GFR and pre-and post-operative Ser appeared to be comparable between the age-stratified groups (P>0.05). However, the 3-month post-operative GFR of the remaining kidney was (74.82±17.42) ml/min in the aged below 50 years old group vs (60.34±13.32) ml/min in the aged 50 years or above group (P<0.05). Donors aged above 55 years required longer hospital stay compared with those aged below 50 years (P<0.05). There was no significant difference in incidence of complications between the two groups (P>0.05). The risk-stratified groups showed similar levels of pre- and post-operative Scr, pre-operative and 3-month post-operative GFR (P>0.05). Conclusions Selection of donors with advanced age or potential medical risks need to be careful. Comprehensive evaluation before operation and rigorous criteria of inclusion should ensure good safety and favorable outcomes.