Abstract
Publications in both the lay and academic press suggest that the problem of long waiting lists for deceased donor kidney transplants could be solved if only the National Organ Transplant Act were changed to permit various forms of financial incentives to kidney donors. The history of the debate over payments to donors is discussed with particular emphasis on the national and international ramifications of such payments, the effect on normative altruistic donation, and the nature of the relationship between the doctor and the patient in the donor workup process. A way forward is proposed through the promotion of financial neutrality and expanded efforts to prevent CKD.