This article briefly reviews the history of organ transplantation. It then addresses the pressures to use living donors from the perspective of developing a process to ensure that this surgical procedure takes place with the informed consent of the donor. The focus is on informed consent and concerns whether people can make a decision free from coercion, and with all available information on the risks and benefits of the decision. This article then puts forth a framework for reviewing laws, policies, and procedures involving informed consent and examines the basis of informed consent for living organ donation from the perspectives of the law, medical ethics, and the individual donor's interests. The article concludes with a series of suggestions to help ensure that the donor makes an informed choice that is as free as possible from the many pressures to donate.