A profound kidney shortage compromises the effective care of renal failure patients in the United States and other nations. This article discusses the need for kidneys, the procurement of live donor and cadaver organs, and strategies to increase organ donation. It suggests that the kidney shortage can be minimized and perhaps eliminated through the use of living related donors whenever appropriate, and through more efficient procurement of volunteered cadaver kidneys. Two other strategies to increase the supply of kidneys–the sale of organs and “contracting out” laws–are rejected. The first is unacceptable in the Western world. The second is fraught with constitutional and ethical problems, and may not lead to more kidney procurement.