Purpose of the reviewThis article examines the trends in consent for organ donations from deceased donors and to give an ethical analysis of why informed consent from donors should be respected for the good of the donor, recipients, and society as a whole.Recent findingsA number of initiatives have been proposed to increase organ donation in the United States such as presumed consent, required response, financial incentives, preferred status, and conscription. However, after reviewing all of these approaches from both a social and an ethical perspective, it appears that the one approach that could work is the present one based on altruism and voluntarism with a few modifications.SummaryDonor authorization would allow competent adults to decide whether they wish to be an organ donor without the added step of seeking surrogate or family consent after death. An individual could register as an organ donor through the Department of Motor Vehicles or have a valid organ donor card that is signed and witnessed. To verify that an individual is an organ donor, there could be the creation of a national organ registry, which would be available around the clock. If an individual is recognized as a legal organ donor, then the transplant coordinator would inform the surrogate or family members of the individual's wish to be a donor and then explain the harvesting process to them. The donor authorization approach would not only respect the individual's right of autonomy and justice, but would be beneficial to recipients and society as a whole.