The World Health Organization guidelines on organ and tissue donation mandate national (or sometimes only regional) self-sufficiency and an absence of remuneration for both blood products and transplantable organs. This chapter critiques these twin principles. We begin with a discussion of the twin principles as applied to blood products, noting the particularly pernicious effects on plasma supply and availability, especially in poorer nations. Turning to transplantation, we emphasize the numerous benefits of international cooperation and cross-border transplantation – benefits that would be undermined by self-sufficiency, especially in smaller countries and those without well-developed domestic exchange programs. We illustrate this point with examples drawn from several noteworthy instances of cross-border kidney exchange. We argue that much of the current discourse around remuneration and organ donation is overdramatic and unhelpful. Although nearly every effort to increase organ donation and transplantation presents ethical challenges, not every such effort amounts to “trafficking” or “a crime against humanity.” These labels stifle helpful deliberation, progress, and consensus. The chapter concludes with recommendations for a saner approach to the scarce resources of blood products and transplantable organs – one that is focused on international cooperation, rather than self-sufficiency; evidence-based policies, rather than a reliance on decades-old assumptions and understandings; and the use of pilot studies and trials to test the ethics, safety, and efficacy of incentives in various settings.