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Purpose of Review: Insufficient availability of human organs for transplantation has given rise to a flourishing global market. This review addresses current thinking and practical considerations regarding legalization of organ sales., Recent Findings: Increasing competition for human organs has led to egregious human rights violations. Governmental proscription of organ sales has failed to slow this process. Organ sales in China and the regulated market in Iran have received much attention. Some believe that a regulated market is an ethical vehicle for shortening waiting lists and decreasing illegal organ sales. Others consider it a blow to human dignity and to altruistic donation. There is alternative support toward reimbursing living donors for their financial losses. The World Health Organization advocates increased reliance on cadaver donor transplantation. Some countries have enacted presumed consent laws that have increased cadaver organ donation. In the USA an Organ Breakthrough Collaborative has generated comparable success., Summary: Serious discussion continues with regard to regulated sale of human organs. There is increased interest in reimbursement for living organ donation. Research is needed to elucidate workings of the global organ market, and to assess attitudes about stakeholders with regard to proposed changes in transplantation policy.