Methods for procurement, processing and distribution of allograft tissues have changed rapidly and many of the advances have resulted in widespread use of allograft tissues for reconstruction. However, unlike other types of orthopaedic implants, these human graft tissues are not simple commodities delivered to the surgeon or operating room in prepackaged sterile containers, but rather are more akin to gifts from a donor to a patient in need. As such, ethical behavior and responsible stewardship on the part of each surgeon and each of those involved throughout the allograft enterprise is required. Surgeons using donated tissues should be aware of the advances and changes within the field and the ethical considerations surrounding human tissue transplantation. The following remarks focus on the generosity of donors and their families and the subsequent responsibilities for the medical community, in particular, the surgeons who use these grafts.