Background: The legal concept of First Person Authorization is based on the principle that the decision to donate by a person with decision-making capacity should be respected even after he or she dies. Although the transplant community supports this concept, implementation has not been universal. Wendler and Dickert’s 2001 study showed that 31% of OPOs followed the next of kin’s wishes in deciding whether to proceed with organ procurement.

Methods: To ascertain current organ procurement practices by OPOs, we surveyed the executive directors of all 58 OPOs. The web-based survey consisted of 21 questions about OPOs' donor registration system and practice patterns.

Results: All 58 OPOs (100%) responded to the survey and they were allowed to skip objectionable questions. Of those who responded to the question, 56 (98%) reported having online registries for donor registration. Thirty-eight (67%) did not have a mechanism to notify the donor’s next-of-kin of the donor’s registration status. Twelve (21%) have adopted the policy of informing the donor family of the donor’s decision rather than asking for the family’s consent. By contrast, 33 (59%) strove to educate the family and achieve familial agreement with the wishes of the deceased, but if unsuccessful, OPOs would proceed with procurement over family objections. However, ∼20% the OPOs would not proceed with organ procurement unless the family consented. When given case scenarios where the donor’s wish regarding organ donation was unknown or when wishes held by the donor and the family conflicted, the following percent of the OPOs were either very likely or somewhat likely to proceed with organ recovery:

Conclusion: Approximately 80% of OPOs have adopted First Person consent. Assessing OPO practices when there are unknown and discordant familial views should be useful in the development of interventions to facilitate policy implementation.

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