UNOS statistics reveal that in 2004, on average, 19 people a day died in the U.S. while on the waiting list. As organ transplantation has moved out of the experimental stage, the number of people with end-stage diseases seeking a transplant has slowly but steadily increased. The number of donations however, has not increased. Sadly, this is not because there are not more potential donors. Various estimates are that anywhere from 60 to 70 percent of potential donations are either refused by the next-of-kin or are never requested.

These estimates take into account the criteria for brain-dead, heart-beating donors and other contraindications. Roughly half of the missed donations appear to result from failure of physicians to either declare brain death in a timely manner, or their failure to notify their Organ Procurement Organization (OPO) of potential donors. The Nebraska Medical Center has implemented the Acute Bereavement Services (ABS) department to avoid this pitfall. This is despite enactment in all 50 states of "required request" legislation that mandates that all potential donations be sought. More recently, in October 1999, HCFA released the Final Rule Amendment which requires all hospitals to notify the OPO of all deaths for review of organ and tissue donation potential.

There are a variety of proposals to increase the number of donations, for example: public and professional education, giving people who have declared their support for donation additional points on the waiting list should they ever need a transplant themselves (preferred status), changing the structure of donation from a required opting-into a required opting-out strategy (presumed consent) and requiring all adults to register their choice of whether they would permit donation in the event of their death (mandated choice or required response).

In Nebraska, legislative efforts have been made to help promote organ and tissue donation awareness and education. In May of 1999, LB147 was passed. It allows $1 to be donated to promote organ and tissue donation when paying the drivers license fee. A new bill in 2003 was passed that would empower the license to be a legal document instead of requiring family to give consent in donating a loved ones organs. This would include the family in the donation process but does not leave the decision up to them. At the time of license renewal, you may indicate whether you wish to be an organ donor.