This chapter addresses the moral and ethical issues surrounding the donor compensation proposal. It takes the standpoint that the moral virtues of public policies have to be assessed in light of the consequences of those policies. Thus, a consequentialist rather than a deontological standpoint is taken here. The chapter examines the moral grounds of three organ donation systems: (i) the “altruistic” system in its current usual form; (ii) an altruistic system with some modifications, which, however, do not encompass compensating donors; and (iii) a system in which donors are compensated financially for their willingness to donate. It is argued that the current system is weak on moral grounds because it accepts avoidable death and suffering, limits individual self-determination and actions of self-defense, and treats organ patients unfairly by allocating organs to patients who have previously declined to be potential organ donors. A system that permits adequate compensation to living and postmortem organ donors is not only more effective, but also morally superior.