Prisoners have generally been excluded from donation because of ethical and infectious disease concerns. We propose a plan, which would address both concerns and examine the potential impact. Interested inmates would approach the prison's medical team expressing interest in living donation (LD). Principle steps in the process are (1) consent to evaluation and a two-step surgical consent. (2) Nucleic acid amplification testing (NAAT). A standard LD workup would be initiated. If the results were acceptable, the inmate would sign the first surgical consent. NAAT for human immunodeficiency virus (HIV) and hepatits B and C virus would be performed 3 weeks apart. Assuming acceptable results, prisoner and family would sign the second consent, and the inmate would be scheduled for LD surgery. The inmate would be in medical isolation until the time of donation. NAAT testing has enabled the window period to be small enough to allow close observation and monitoring of the prisoner, enabling safe donation. The paternalistic protection of prisoners would ensure that experiments were not performed. This plan would allow prisoners the ability to participate in opportunities provided noninmate people. There are currently 2.2 million inmates; the incidence of HIV is 1.8%, decreasing the potential pool to 2.1 million. A donation rate of 1% could provide 21,000 kidneys. Advances in medical technology and the acknowledgment that prisoners can consent to complex but standard medical procedures have opened up a potential pool of organ donors that could dramatically impact the organ shortage.