Living related organ transplantation is morally problematic for two reasons. First, it requires surgeons to perform nontherapeutic, even dangerous procedures on healthy donors - and in the case of children, without their consent. Second, the transplant donor and recipient are often intimately related to each other, as parent and child, or as siblings. While partial liver transplantations are now more common, at the time of the early procedures many commentators objected on ethical grounds. Many of these ethical objections, rather surprisingly, appealed to notions of autonomy. Because the procedure is nontherapeutic for the donor, it is not surprising that sibling-to-sibling kidney transplantations have often wound up in the courts. What is more surprising is the reasoning and willingness of US courts to authorize these transplants. The best interests standard is a formal and abstract framework; families are intimate and particular associations.