Asymmetry between the supply of and demand for transplantable organs necessitates rationing and should ideally serve as a spur to ethical reflection and policy innovation. Transplantation policies can be animated by various principles, such as maximizing total benefits and fairness. Implicitly, these principles demand that we interrogate our beliefs about the meaning of and appropriate role for disability in the face of scarce resources. How we conceive of disabilities – whether as a “mere difference” or a “bad difference” – influences our thinking about both donation and allocation of organs and should, therefore, be made explicit.