Dr. Meshkov notes several flaws in the essay by Klassen and Klassen [1]. These include using preliminary experience in Virginia to predict that mandated choice would fail and exaggerating the difficulty in collecting wishes about organ donation (the authors themselves note that such information is now "routinely available" in several states). Dr. Meshkov's comments and personal story also vividly show that although transplantation does raise many ethical issues, the dire need for organs is not one of them.

The Klassens make other erroneous claims and inferences. Mandated choice does not presume that prospective recipients are "the rightful owners of all potential donors' organs." On the contrary, mandated choice is based on the belief that each person should control the disposition of his or her own body after death [2]. Mandated choice does not create a "paradoxical moral dilemma." In keeping with the goal of protecting individual autonomy, the wishes of nonconsenters, as well as those of consenters, should of course be honored. No evidence supports the statement that "family acceptance of the procurement process has remained vital" to successful organ retrieval. Alternative approaches have never been tried in the United States. There is also no evidence that mandated choice would turn public opinion against transplantation; in fact, opinion surveys suggest otherwise [3]. Mandated choice in no way minimizes the importance of public education and family discussion; rather, it encourages these important activities by increasing awareness of the great value of organ donation [4]. Mandated choice does not preclude the worthwhile goal of discovering why some people choose not to donate. Finally, mandated choice does not ignore the family [4]; it simply places the ultimate control over organ donation where most of the public seem to think it belongs [3]-with the individual.

Although I share Dr. Meshkov's optimism about mandated choice, my view of public altruism is not as bright. The Klassens may be right that mandated choice would not work, but, without a fair trial, how can they be so sure? As Dr. Meshkov implies, in our quest to overcome the organ shortage, we need to move beyond armchair debates based on abstract reasoning and to start trying new reasonable ideas. Therefore, I again call for a carefully designed pilot trial of mandated choice and ask that indictments not be handed down before the data are in.