Objective To propose ex vivo ureteroscopy (ExURS) and technical modification to render the donated kidney stone-free at live donor renal transplantation.Methods A suitable kidney donor with small unilateral nonobstructive calculi in the lower calyx of left kidney underwent laparoscopic live donor nephrectomy. After cold perfusion, ExURS was performed immediately in an iced saline solution. A F8.0/9.8 semirigid ureteroscope was accessed to collecting system via the ureteral stump. A 'Pull-up'skill was applied in order to facilitate the atraumatic access to the pelvis. The harvested kidney was rotated so as to facilitate the semirigid ureteroscope access to the lower calyx. The calculi was then completely endoscopic fragmented with holmium and removed. Results The warm ischemia time was 3 min and the cold ischemia time was 2.5 h. The procedure time was 18 min. There were no intra-operative or postoperative ureteral complications. The urine volume of recipient was 6260 ml in the postoperative day. the serum creatinine of 1 to 4 postoperative days were 402 μmol/L, 186 μmol/L, 136 μmol/L, 112 μmol/L, respectively, which was normal 4 days after operation. The serum creatinine maintain at 100 μmol/L approximately, in 6 months follow up.Conclusions ExURS is a technically feasible means of rendering a stone bearing donor kidney stone-free safely and efficiency.