The article by Spital [1] and that by Klassen and Klassen [2] present many, but not all, of the ethical and practical considerations involved in organ donation. As a practicing physician who has been involved in the donation process and as a recipient of a cadaveric renal transplant, I have been able to see many sides of this issue. Klassen and Klassen claim that many families that reject donation are convinced that their dying relative agrees with their views. Do the authors really believe that parents of teenagers and young children have had such a discussion with their children? It has been my experience that the usual reason for rejection involves some poorly defined religious principle, probably because this is an easier stance to take in response to the inquiries of the procurement team than simply saying no.

The Klassens' article also notes the potential difficulty in establishing a system to identify donor status. Anyone who has ever been stopped on a highway by a police officer is amazed at the speed at which demographic information about the driver is obtained. Why cannot the hospitals take advantage of this system through the police? If police computers know someone's age, birth date, and address, the addition of donor status to the database would seem to be a minor change in the computer software.

I strongly believe that continued efforts aimed at public education about the enormous success of transplantation should be encouraged and funded. I was pleased to see recently that cardiac transplantation was the topic of a long series of front-page articles in The Philadelphia Inquirer; almost all of the emphasis was placed on what the patients and families went through in their quest for a second chance at life. This aspect of the problem is most often ignored by policymakers.

As a patient receiving dialysis, my wait was prolonged, forcing major disruption in my career and family life, as well as creating anxiety and stress for many months. Fortunately, I had the option of dialysis to keep me alive until a donor organ became available. For those in need of a liver, bone marrow, or a heart, the wait is often fatal. A program of mandated choice is worth the effort, because it is unlikely to result in a worse situation than exists currently. I would suspect that, with better education of the public, young people in particular would agree to be organ donors in far greater numbers than were reported in the Virginia study.

The gift of organ donation by an individual or a family in the midst of great personal tragedy is an expression of the finest impulses in the human spirit. I truly believe that this impulse exists in all people and that we must do all that we can to allow them to participate in this miraculous act of giving. Some of our ideas may be successful and others, not; but, as Dr. Spital points out, with this many lives at stake, we cannot continue "our current inefficient approach to organ procurement."