Live kidney donor evaluation mandates anatomical and functional assessment of the donor kidney. Helical computed tomography (CT) with advanced 3-D techniques provides detailed description of the vascular, parenchymal, and collecting system. We compared the accuracy of helical CT angiography with intra-operative findings in the evaluation of 102 live kidney donors. Identification of vascular anomalies was best on direct viewing of the axial images using interactive scrolling through the images and cine-loop paging. In 204 kidneys evaluated, a single renal artery was present in 74.5% and a single renal vein in 87.5%. Multiple renal arteries were more common on the left side (31%) vs the right side (20%). Early branching of the arteries was seen with equal frequency (approximately equal to 10%) on either side. Multiple renal veins were more often on the right side (20%) vs the left side (5%), and one patient was found to have double inferior vena cava. CT angiographic findings were concordant with the intra-operative findings in 97% of the cases, missing a small renal vein, an accessory artery that was visualized in retrospect, and a very early branch that was read as accessory artery. CT also revealed cortical cysts (four cases), duplex collecting system (two cases), hydronephrosis (one case), renal stone (one case), and liver haemangioma (two cases). CT angiography is highly accurate for detecting vascular anomalies, and providing anatomical information. It may serve as the primary tool for donor evaluation.