For more than 10 years, organ procurement organizations (OPOs) have publicly lamented the fact that organ donation rates have consistently remained stagnant. The past few years have witnessed a significant increase in the number of deceased donors; however, the number of organs recovered from deceased donors is not enough to meet the increasing demand.1 The disparity between the number of organs available for transplantation and the number of patients in need continues to grow. Refusal by families of potential donors to give consent for donation continues to be a major obstacle in organ donation.2,3 

Many solutions have been proposed to increase consent rates, including mandated choice, presumed consent, and financial incentives for donation. The OPO community has always concerned itself more with the actual decision than with the motivation behind the decision. Little is known about why some individuals decline to donate, and even less is...

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