Surgically replacing organs in the human body has become an acceptable and successful procedure in Western medicine. In more recent years, replacing major organs in the human body with those procured from deceased or living donors has become commonplace. Disparities exist at the earliest stages in the donor and transplantation process in that American Indians experience a higher prevalence of chronic diseases, which often require organ transplantation, and as a result suffer from high morbidity and mortality. Currently, nearly one thousand American Indian candidates are on the transplant waiting list in the United States. Despite the fact that American Indians are disproportionately in need of donor organs, they are significantly less likely to consent to donation than other racial or ethnic groups. Consequently, a lack of organs that are compatible matches for American Indian patients can add to long waiting periods for transplantation and contributes to higher death rates. A better understanding of the barriers, facilitators, and opportunities for organ donation and transplantation is needed for American Indians. This article attempts to fill this gap by reporting on the results of a dialogue between traditional American Indian healers and Western health-care providers regarding the barriers and facilitators to organ donation and transplantation. (Contains 11 notes.)