Despite extensive surgical training, many transplant team members including surgeons may feel ill prepared in the area of medical ethics. The breadth of transplant surgery ,including the need to balance the needs of multiple patients, and the frequent interaction with issues surrounding death, expose the transplant team members to a variety of ethical concerns. The practicing transplant team members should be prepared to deal with the ethical issues that are integral to this broad spectrum of clinical encounters. Certainly no text or course of study could prepare one for each possible clinical scenario and its associated ethical concerns. This chapter will provide a framework for understanding and addressing the ethical issues that arise daily with patients and families. It is anticipated that this discussion will include some familiar as well as new perspectives on medical decision-making. As transplant team members considering ethical issues in organ donation it may help to adopt the understanding that donation may best be viewed as a voluntary act that has the potential to morally elevate mankind, rather than seeing the human body as a repository of parts.