A Dutch TV station says it will go ahead with a programme in which a terminally ill woman selects one of three patients to receive her kidneys.
The show comes from Big Brother creators Endemol
Political parties have called for The Big Donor Show to be scrapped, but broadcaster BNN says it will highlight the country's shortage of organ donors.
"It's a crazy idea," said Joop Atsma, of the ruling Christian Democrat Party.
"It can't be possible that, in the Netherlands, people vote about who's getting a kidney," he told the BBC.
The programme, from Big Brother creators Endemol, is due to be screened on Friday night.
The 37-year-old donor, identified only as Lisa, will make her choice based on the contestants' history, profile and conversation with their family and friends.
Specialists in kidney transplants have condemned the programme
Viewers will also be able to send in their advice by text message during the 80-minute show.
The Dutch donor authority has condemned the show, as have kidney specialists in the UK.
"The scenario portrayed in this programme is ethically totally unacceptable," said Professor John Feehally, who has just ended his term as president of the UK's Renal Association.
"The show will not further understanding of transplants," he added. "Instead it will cause confusion and anxiety."
Professor Feehally also pointed out that, under normal circumstances, two people would benefit from a donor, each receiving one kidney.
"The set up of the programme bears no relationship to the way decisions are made about transplants in the real world," he said.
"Living donors can choose altruistically to give one of their kidneys - usually to a family member.
"If organs become available after someone dies, health professionals with access to detailed information about those waiting for a transplant make objective decisions about who should receive those particular kidneys."
The former director of TV station BNN, Bart de Graaff, died from kidney failure aged 35 after spending years on a transplant waiting list.
BNN chairman Laurens Drillich has defended the show
"The chance for a kidney for the contestants is 33%," said the station's current chairman, Laurens Drillich. "This is much higher than that for people on a waiting list."
"We think that is disastrous, so we are acting in a shocking way to bring attention to this problem."
"For years and years we have had problems in the Netherlands with organ donations and especially kidney donations," agreed Alexander Pechtold of D-66, the Dutch social liberal party.
"You can have a discussion about if this is distasteful, but finally we have a public debate," he told BBC Radio 4's Today programme.
TV critics in the UK have expressed horror at the programme, but said such a show would be unlikely in Britain.
"My first reaction, probably everyone's reaction, is that this is as dangerously near as we've got to a TV programme playing God," said Julia Raeside of the Guardian newspaper.
"People may live or die on the result of a game show. It's a step too far.
"I don't think this is anything to do with reality TV. It's just a crazy idea that would never play out over here."
The outcry comes at a difficult time for production company Endemol, who were censured by Ofcom last week for their handling of the Celebrity Big Brother racism row.
The Australian version of Big Brother has also drawn criticism for not telling a contestant that her father had died.