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Purpose of review: Whether financial or other incentives for organs should be allowed or prohibited is one of the most challenging ethical issues facing the transplant community. This review provides an overview of the current status of the ethical debate on this issue. Recent findings: Currently, the buying and selling of organs from either living or deceased donors is legally prohibited in many parts of the world in order both to prevent the commercialization of organs and to ensure some level of equity of access to organ transplantation. Still, a number of proposals have been put forth in recent years suggesting that some form of financial compensation (e.g. direct payment, reimbursement, tax credits) or other 'moral' incentives (e.g. honorary medals) should be permitted or explored. An emerging issue that has recently received considerable attention is public solicitation of organs from living and deceased donors through commercial venues, which is seen by some as a potential means for the wealthy to gain an unfair advantage in obtaining an organ. Summary: This review tracks the ethical debate regarding the commercialization of organs along a 'commercialization continuum', with direct payment for organs at one end and public solicitation at the other.

The commitment of transplant physicians to protect the physical and psychological health of potential donors is fundamental to the process of living donor organ transplantation. It is appropriate that strict regulations to govern an individual's decision to donate have been developed. Some may argue that adherence to such regulations creates a doctor-patient relationship that is rooted in paternalism, which is in drastic contrast with a doctor-patient relationship that is rooted in patients' autonomy, characteristic of most other operative interventions. In this article we analyze the similarities between cosmetic plastic surgery and living donor surgery as examples of surgeries governed by different ethical principles. It is interesting that, while the prevailing ethical approach in living donor surgery is based on paternalism, the ethical principle guiding cosmetic surgery is respect for patients' autonomy. The purpose of this article is not to criticize either practice, but to suggest that, given the similarities between the two procedures, both operative interventions should be guided by the same ethical principle: a respect for patients' autonomy. We further suggest that if living organ donation valued donors' autonomy as much as cosmetic plastic surgery does, we might witness a wider acceptance of and increase in living organ donation.