OBJECTIVES: To reflect various approaches for organ procurement such as altruism, altruism combined with financial incentives, reciprocity, and indirect/direct financial incentives for organ donation. To elucidate the values and preferences of the public regarding organ procurement systems. METHODS: Concepts and theories of altruism identified in economic literature are applied to transplantation. This theoretical overview has been extended by a comprehensive literature search that identified 48 international surveys and studies which empirically explore public attitudes towards human organ donation and financial incentives for deceased and living organ donation. RESULTS: The identification of a series of alternative approaches of human organ donation reveals that donation based on altruism alone may have become too costly for a community as voluntary donations have remained almost flat during the last decades, while the number of patients on waiting lists have attentively increased. The value of these lost lives seem to be evaluated lower than keeping altruism as the main principle of donating organs. As a cosequence some stakeholders have been questioned that altruism is enough to meet increasing demand for organs and propose supplementing the principle of giving by introduction of financial incentives for donors or fully replacing it by pricing mechanism. For a community choosing any of these donation approaches it is especially important not only to be attracted by some appeal any proposal may offer but to further investigate the implicit assumptions and their potential limitations the donation policies are based on. While it is estimated that the debates on the ethics of organ donation are well understood by those involved in organ procurement and donation, the values and preferences of the public regarding organ procurement systems under scientific discussion are not that well known and therefore have to be elucidated. Though, 48 international surveys and studies to investigate public attitudes towards human organ donation and financial incentives for deceased and living organ donation have been identified in a comprehensive literature search, it is revealed that it is unknown whether e.g., the opportunity for trading one's organ(s) is determined by community values. CONCLUSIONS: Transplant decision-makers should rather than imposing their values to the community, instead should answer to community values. It is necessary to identify the community preferences and values with respect to the organ procurement proposals and prepare on this informed basis an adequate donation policy which is in line with community values. The process of consulting the community may reveal that individuals are altruistically motivated and would donate their organs after death, and that all is missing is mutual trust. An informed ethical debate and dialogue between members of the transplant expert community and the public is needed to decide which organ procurement approach best reflect the communities' shared values.