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I welcome the opportunity to address the interesting responses to my article.1Sharif A. Presumed consent will not automatically lead to increased organ donation.Kidney Int. 2018; 94: 249-251Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar Tafran2Tafran K. Criticizing the critique on the presumed consent system.Kidney Int. 2018; 94: 1023Scopus (1) Google Scholar cites the work from Abadie and Gay3Abadie A. Gay S. The impact of presumed consent legislation on cadaveric organ donation: a cross-country study.J Health Econ. 2006; 25: 599-620Crossref PubMed Scopus (315) Google Scholar to support the belief that presumed consent, corrected for factors such as mortality using regression analysis, leads to increased organ donor rates in contrast to findings from Coppen and colleagues.4Coppen R. Friele R.D. Marquet R.L. Gevers S.K. Opting-out systems: no guarantee for higher donation rates.Transpl Int. 2005; 18: 1275-1279Crossref PubMed Scopus (39) Google Scholar Published in 2006, and exploring a cohort dated between 1993 and 2002, historical studies should be interpreted cautiously in the contemporary era. For example, mortality was defined by Abadie and Gay as death from motor vehicle or cerebrovascular accidents, and these events are a declining cause of death globally (http://apps.who.int/healthinfo/statistics/mortality/whodpms/). Organ donation has evolved significantly in the last two decades and it remains unclear whether presumed versus explicit consent by itself makes any difference to organ donor rates in current environments. Regardless of both consent systems, actual organ donation can only proceed with approval from next-of-kin in the majority of countries, and this is the major hurdle that requires a change of attitude. Spital and Taylor5Spital A. Taylor J.S. Routine recovery of cadaveric organs.Kidney Int. 2018; 94: 1023Scopus (1) Google Scholar propose the routine recovery of organs from deceased donors (without the need for next-of-kin approval), with a thoughtful discourse of the underlying rationale to support such bold intervention. Although provocative, it encourages “blue sky” thinking on how we actually increase organ donor rates. Rather than resuscitating stale arguments of presumed versus explicit consent, we must embrace bold ideas to tackle passive attitudes that remain the actual obstacle to boosting organ donation rather than how we simply register potential donors. Presumed consent will not automatically lead to increased organ donationKidney InternationalVol. 94Issue 2PreviewThe United Kingdom Parliament has proposed a consultation period as part of its plan to introduce presumed (also termed deemed) consent for organ donation in England. However, a Private Members’ Bill (Organ Donation [Deemed Consent] Bill 2017–2019; available to view at https://services.parliament.uk/bills/2017-19/organdonationdeemedconsent.html ) has already started the legislative process and recently passed its second reading in Parliament in February 2018. As it awaits a Public Bill Committee date, it could become the legislative conduit to introduce presumed consent across England. Full-Text PDF Open ArchiveCriticizing the critique on the presumed consent systemKidney InternationalVol. 94Issue 5PreviewI read with interest the paper from Sharif,1 which argues that the presumed consent system (PCS) would not automatically improve deceased donation rates in the United Kingdom. I believe that the PCS is not a magical solution for the organ shortage. However, some of the critique against this system seems inaccurate. Full-Text PDF Open ArchiveRoutine recovery of cadaveric organsKidney InternationalVol. 94Issue 5PreviewWe agree with Sharif that presumed consent will not eliminate the organ shortage and that “more radical strategies are required.”1 One that should be considered, but rarely is, is routine recovery of cadaveric organs without consent.2 Because relatives often say no, requiring consent is deadly for potential recipients yet is accepted as necessary to show respect for autonomy. This principle is designed to protect and promote a person's interests, but decedents have no interests and cannot be harmed. Full-Text PDF Open Archive