The study by Siminoff and colleagues [1] is significant; however, it overlooks the role of the organ procurement organization (OPO) in offering the option of organ donation to the families.

A survey of OPOs done last year by the Association of Organ Procurement Organizations showed that when hospital staff approached families and offered the option of donation, the consent rate was about 46%. This figure is consistent with those of Siminoff and colleagues' study. However, when a coordinator from the OPO was on site and involved in requesting donation, the consent rate was about 71%.

Former Pennsylvania Governor and transplant recipient Robert Casey passed landmark organ donation legislation before leaving office this year. The new law places the responsibility of offering families the option of donation squarely in the hands of the OPO or hospital professionals trained by the OPO.

It has been clearly shown that when the family is offered the option of donation by a coordinator with the OPO in cooperation with the hospital's medical team, the chances of obtaining consent are greatly increased. In Siminoff and colleagues' study, a representative of the OPO seems to have been involved in requesting donation in fewer than 9% of the cases!

An important point in Siminoff and colleagues' study is that no one factor can solve the organ donor shortage. Increased awareness through public service advertising campaigns undertaken by the national Coalition on Donation and the Advertising Council will result in the ideal situation—more families introducing the discussion of donation when faced with a family tragedy.

When the family does not broach the subject first, however, the hospital team caring for the patient must address the request with much care and sensitivity, preferably by placing the responsibility in the hands of the OPO.