All things considered, one is tempted to answer the question in the title: How presumed is presumed consent? Not very, or not at all. It is evident that, regardless of the law, be it opting in or opting out, presumed consent or presumed nonconsent, the family is almost always consulted. The family has the preferential right of interpretation. Their interpretation of the attitude toward organ donation by the deceased is usually not contested, whether it is in agreement with or contrary to the stated (verbal or written) view of the deceased. This is understandable and proper; the sudden and unexpected death of a close relative is the start of the grieving process and, besides, relatives might take legal action if their opinion is not respected. Taken together, it can be argued that well-designed presumed consent legislation is the best system for many of the reasons stated. Foremost among these is that it offers a very good way to initiate consultations with the family. With due respect for any legal system, one does not discuss the legal aspects with the relatives. Since they are expected to honor the opinion of the deceased, there is reason for each of us to make our wishes regarding organ donation known to our relatives. It might relieve them of a difficult decision.