To the Editor.
—The plea by Dr Spital1 for a system of mandated choice in organ donation is flawed as a plan to increase the supply of organs and as an ethical proposition. He reports that 63% of those surveyed would agree to donate under a mandated choice system, but this is barely more than the estimated 60% of families that now permit donation when approached. Moreover, Spital ignores the powerful forces that mandate family involvement in organ donation decisions and would continue to act to limit actual donation rates.The Uniform Anatomical Gift Act allows hospitals to remove organs without family permission when a donor card has been signed, but hospitals do not do so because the staff are not willing to ignore the wishes of the family. Ethical and public relations considerations both suggest bowing to family preferences. Family consultation would be conducted under mandated choice just