The use of a live donor as a source for organs for transplantation is a unique act in medicine. With very few exceptions, the basis for medical treatment is the benefit for the individual patient. However, in the case of a live donor, we actually harm - or at least potentially harm - a healthy individual for the benefit of someone else. A free and truly informed consent is the basis for live donation. The potential donor must be capable of understanding the information given and the decision to donate should be voluntary and without coercion. The Amsterdam and Vancouver Fora on live donation establish the responsibility of the transplant team to perform complete medical and psychosocial evaluation and to care for the donor during post-operative recovery. There is also the responsibility to facilitate long-term follow-up and treatment and to identify and track complication. It is recommended that the donor should be evaluated by a different team than the one caring for the recipient. The scarcity of organs is a worldwide problem. No country has a true excess. Still, a global trade in organs has developed with transplant tourism and even trafficking of donors and organs. WHO has estimated that 50,000 kidneys are transplanted yearly worldwide. 20,000 of them are from live donors and the number of trafficked organs is estimated to be between 5,000 and 8,000 per year. A number of scientific gropus have performed psychosocial evaluation of paid donors and the results in Iran, Pakistan and the Philippines are similar. A majority of the donors regret donation and they feel that they have not recovered fully. In the absolute majority of cases, the economical situation one year after donation has not improved. It is important that all countries with transplantation activities have a regulatory framework for live and deceased donation. To lessen the burden on live donors it is likewise important to establish and promote deceased donation globally.