BACKGROUND: It has been reported that living liver donors may develop psychological or psychosocial impairments after transplantation, although the majority of them do not develop much difficulties. Their postoperative psychological prognosis may be affected by the way they made their decision to donate. The purpose of this study was to investigate the association of donors' preoperative psychological factors with the processes of their individual decision-making to donate and their family-level decision-making to select one donor among themselves. METHODS: A total of 165 living liver donor candidates underwent a semistructured interview, several standardized psychological tests, and a quality of life measurement. The results of the tests were compared among the groups classified according to the types of their individual and family decision-making processes. RESULTS: Donor candidates who made a "postponement decision" had higher trait anxiety and higher alexithymia scores than candidates who made a "deliberate decision," and candidates whose family made a "de facto decision" had higher trait anxiety and higher alexithymia scores than candidates whose family made a "decision of consensus," which indicates that those who have high trait anxiety or alexithymia may tend to take a "postponement" pattern in the individual decision-making process and a "de facto decision" pattern in the family decision-making process. CONCLUSIONS: The results indicate the importance of noting living donors' psychological traits for providing them appropriate preoperative psychological support.