There remains a tremendous shortage of organs for transplantation, and many patients have prolonged waiting periods before receiving a transplant. This occurs in spite of data showing that (1) the general public supports transplantation and organ donation, and (2) a much larger number of donors is potentially available. Current legislation creates an environment that is awkward and often hostile to organ donation. As a result, many physicians do not refer potential donors and many families refuse consent. Presumed consent legislation would create a more favorable environment and has the potential of markedly increasing the number of potential donors whose organs could be used. Arguments against changing the law to ‘presumed consent’ have emphasized that other remedies would increase the number of donors. However, these remedies have been in effect for almost two decades without a marked increase in organ donation. We recommend reconsideration of legislative changes to enable ‘presumed consent’ to be in force.