Living related donors are an increasing source of organs for transplantation. Although the use of this type of donation is widespread in the United States, the practice of placing donors at risk for injury or illness without physical benefit can create ethical dilemmas for health professionals dedicated to healing and avoiding harm. It is important for transplantation professionals to be familiar with the risks and benefits associated with living donation within their own specialty area. Placing living donation within an ethical framework can allow for careful consideration and guide decision making in each individual case. Drawing upon the literature for examples from several of the transplantation specialty areas, this article reviews some of the risks and benefits associated with living donation and identifies the limits of the utilitarian and casuistic ethical framework in guiding decision making in living donation. An ethical framework of virtue-principlism is offered as one which is grounded in an understanding of what it is to be human and in the nature of the health professional-patient relationship.