This provocative article presents a case for living kidney sales, including investigating many ethical questions and barriers to instituting this policy. Historically, organ sales were condemned at a time when cadaveric donations were believed to be both plentiful and of the same quality as living donors. Thus, risks to the living donor were seen as unnecessary. Today, the landscape looks quite different. Mortality rates for uninephrectomy (removal of a single kidney) are very low (0.03%), the waiting list for kidneys is growing exponentially, and current donor lists have flat-lined despite creative expansion measures. This leaves more patients dying on the waiting list and dependent on costly and painful dialysis. Matas argues that the current situation warrants reopening discussions of living donor incentives within a regulated system and offers some potential constructs for a government-regulated organ vendor system. He also points out that organ donation personnel have been missing from discussions on monetary incentives and calls for their participation. Finally, he presents a series of unknowns which warrant further investigation, such as the effect of monetary vendor incentives on altruistic donation and current opinion (public and lawmaker) on the subject. Overall, Matas presents a compelling case to look at kidney sales not as an interesting hypothetical question, but as a real-life, real-time meeting of ethics with lives hanging in the balance.