The global criticism of organ trafficking and transplant tourism requires many countries to pursue legal protection of living organ donors for organ transplantation. Japan is one of the criticized countries: more than 26 000 people have become living organ donors. This paper presents an exploration of living liver transplantation in Japan from legal, social and ethical perspectives. Since the first living liver transplantation in 1989, the cases have increased, with extremely high dependency in spite of a few deaths and cases of severe disability. Government and professional guidelines stipulate that living donors be “relatives” so that living organ transplantation can be privatized and regarded as a family issue, although it is strictly limited to altruistic cases in some countries. Based on results of the Living Liver Donor Survey conducted in 2004, Japanese liver donors have had various experiences. Most male donors were employed, felt some obligation and had concerns about financial effects or employment during decision-making. In contrast, only a quarter of female donors were employed, felt guilty for their children, and did not have opportunities for regular health checkups after donation. Severe tensions and family break-up were observed in adult-to-adult cases, although donors were satisfied with donation overall. The author suggests that we should rethink privatization of living organ donation and that independent advocates should support potential donors. Further research is necessary to explore the reasons why organ donation is privatized even in some forms of cadaver cases in Japan.