While the Atlantic Ocean is ventilated by high-latitude deep water formation and exhibits a pole-to-pole overturning circulation, the Pacific Ocean does not. This asymmetric global overturning pattern has persisted for the past 2-3 million years, with evidence for different ventilation modes in the deeper past. In the current climate, the Atlantic-Pacific asymmetry occurs because the Atlantic is more saline, enabling deep convection. To what extent the salinity contrast between the two basins is dominated by atmospheric processes (larger net evaporation over the Atlantic) or oceanic processes (salinity transport into the Atlantic) remains an outstanding question. Numerical simulations have provided support for both mechanisms; observations of the present climate support a strong role for atmospheric processes as well as some modulation by oceanic processes. A major avenue for future work is the quantification of the various processes at play to identify which mechanisms are primary in different climate states.