Commerce in transplantation is well known, if not well defined. Although the word commerce suggests an exchange of money, in reality it often simply signifies a non-profit-making transaction. Nevertheless, money, and therefore profit, may be involved in some human organ transactions, and the buying and selling of organs for transplantation remains common in too many countries. Clearly, if such ... [Show full abstract] transactions were allowed to continue only those who could afford to pay would benefit. They would probably also lead to an increase in the number of media horror stories. A number of such stories have appeared in the past. Although they are rarely based on hard evidence, they do influence politicians and, as a consequence, affect legislation and the availability of organs for transplant. They may also diminish the willingness of the general public to become organ donors and contribute to the persistent poor supply of organ donors. Organ exchange organizations, such as Eurotransplant, have made many efforts to prevent unethical transactions. Nevertheless, stories of such transactions continue to appear and are unlikely to abate while there is a high demand and poor supply of organs for transplantation. An international donor surveillance committee--a clearing house for information on malpractice--could be one solution to the problem as it would prevent doctors from taking part in unethical transplant procedures.