In June of 1964, the World Medical Association developed the ‘Declaration of Helsinki’(available at www.wma.net) as a statement of ethical principles to provide guidance to investigators and physicians involved in human research. Over 40 years later the declaration remains ‘. . .a respected institution and one of the most influential documents in clinical research’ [1]. Though it is not binding to any local or international law, it draws its authority from the degree to which it has been codified, or influenced, as well as from national or regional legislation and regulations. Despite criticisms, the declaration is widely accredited with improving both the ethical and scientific quality of clinical research. It should be recalled however that the Helsinki Declaration was not developed and adopted in a vacuum; it was a response to horrific abuses of human rights, in the name of scientific research and medical progress, such as those perpetrated on inmates of Nazi concentration camps. In April of 2008, representatives of the international organ transplant community will be meeting in Istanbul to face a situation that bears comparison to that faced by clinical researchers in the 1960s. Documents-designed to codify the ethical treatment of living donors have been published by professional transplantation organizations but their impact is limited [2,3]. The use, by Chinese authorities, of organs from executed prisoners [4] certainly ranks as a crime against humanity and an abrogation of basic human rights, as does the exploitation of destitute or vulnerable organ ‘donors’ by traffickers in many parts of the world. All the parties in the vigorous debate that is taking place in the lay and professional press over the wisdom of commercialization of living donation abhor these abuses. The core of the debate is how best to put an end to such abuses. As we struggle to find an answer, what can we learn from