Reality shows have often toed the line between taste and tact–think “Who Wants to Marry a Millionaire.” But there have been times when audiences find a concept even too distasteful for their voracious appetites–remember CBS’s cancelled-after-one-airing “The Will,” wherein the contestants vied for the inheritance of a ranch in Kansas? Or how about the British reality/dating show that never aired thanks to the contestants who threatened to sue after they discovered the hot woman they had all been snogging was actually a pre-op transsexual?

But even duping men into a “Crying Game”-esque situation seems tasteful when compared with Endemol’s (who brought us “Big Brother”) latest reality offering: “The Big Donor Show.” This Dutch show features a 37-year old woman with an inoperable brain tumor deciding which of three candidates is most deserving to receive one of her kidneys. She bases her choice on interviews with the contestants as well as with friends and family.

Viewers will be able to text in their vote, but the ultimate decision lies with the living donor, dubbed “Lisa.” (Once Lisa has passed away, her other kidney can be made available for the national organ registry but cannot be designated for a specific individual.)

“We know that this program is super controversial and some people will think it’s tasteless, but we think the reality is even more shocking and tasteless: Waiting for an organ is just like playing the lottery,” Laurens Drillich, chairman of the BNN network, said in a statement as reported by the AP. In fact, the network claims, the show is a way “to draw attention to a shortage of organ donors.”

Clearly, Lisa should be able to choose to whom she would like to give a kidney. It’s done all the time in this country; family and friends often act as living donors for loved ones. And as much as I would like to defend the show as crass but bringing attention to an important issue, I just cannot. And I even defended “The Swan.”

But, this is life and death, not “outwit, outplay, outlast.” This is the real “Survivor.” These people are desperate not for the million dollar prize, but an organ (even if their percentage of receiving a kidney on the show is far higher than if they were waiting on the national list). Maybe if this process was wrapped in the hygienic, academic veneer of a documentary–perhaps an inspirational story of a woman looking to find a good person who will go on to do great things with the new kidney–the concept would go down easier.

I’m going to stop short of calling it a small-screen snuff film, but the fact that there is audience participation makes it feel a bit too much like the gladiatorial games of Rome–where the audience members were polled for a thumbs up or a thumbs down to determine the fate of the fighter.

“The Big Donor Show” is set to air this Friday on the Netherland’s channel BNN.