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The developing world is faced with several major challenges and hence transplantation becomes a low priority in most countries. As a result the transplantation rate is vey low in most developing countries. The commonest transplantation is that of kidneys and due to lack of dialysis facilities the awareness about the transplantation is generally very poor. Living donors are the commonest source of kidneys but in some countries use of unrelated donors have resulted in selling of kidneys to the rich in their own country or for recipients coming from richer neighbours.The strategy of increasing organ donation and transplantation would begin with prioritizing the end stage organ failure in their respective healthcare system. The transplant centres should preferably be established in public sector hospitals so that the profit motive currently seen in private sectors is not operative. Comprehensive legislation for transplantation of living and deceased donors should also be considered a priority as the framework will be very useful in preventing unethical transplantation.Major renal and liver centres in the country in the public sector could be strengthened to become the flagships in promoting the clean image of transplantation (e.g. SIUT) which the people can see as examples of transparency being fair and equitable for all stake holders. Economic does play a significant role in promoting transplantation but the religious and cultural issues are often equally important. However organizational aspects have recently been identified as the most important and several successful programmes in Asia have reinforced these factors more than the others.Since the donor and recipient are both members of the society, the transplant based on beneficence and altruism is appreciated and therefore sale or commerce in transplantation is looked down upon. The ethical principles in transplantation are universal and poor resources should not be any excuse for promoting transplantation for only those who could pay.