When insurance and organ transplantation intersect, the most essential principles of both fields collide. Insurance requires a sense of objectivity and steadfast adherence to policies that serve to sustain its own survival in economic reality, where the decision to fund one patient’s lifesaving operation will force trade-offs in coverage for the rest of the insured base. Meanwhile, the practice of organ transplantation necessitates a more emotional appeal to the values that we admire most in society - qualities of altruism and gratitude at the foundation of how our donative process functions. The by-products of the ensuing clash are real, definable and quantifiable. By recognizing how insurance impacts the practice of organ transplantation, we may start to salvage the more damaging components of the relationship and reinforce the ways in which the two fields complement each other.