The real stink is about the problems of organ donation from somebody who is dying (contrary to intuition, you cannot get an organ from a dead person, even if they've only been dead 15 minutes. Chances of success are not zero, but so low it's only done as a very last resort). So what people think happens, that when you die organs are harvested, is not what happens. Sadly, that just doesn't work in the real world. Organs are harvested from live people.

The main reason people that you want organs from die is heart failure, doubly so for young people (if you bleed to death, say a large open wound, what kills you is failure of the heart to maintain pressure in your circulatory system. Internal bleeding ? Ditto ... So most accidental deaths are heart failure. ). Things like car accidents, falling of a building, stabbings accidental and otherwise, getting shot, ... all of these generally lead to heart failure.

If you die from heart failure, at the point where your brain stops working all the organs except the heart and lungs will have failed (the body has a priority system for blood distribution : first the heart and lungs. Then, for pregnant women, the baby and the womb and muscles involved in birth, then the brain, then the systems and organs in your trunk, then your extremities. If you intend to ever have a kid, I suggest you never read the medical literature on what can happen to a woman during childbirth, and learn this by hard: NEVER, for any reason whatsoever pull on a birth cord or cut it. Just put the baby on top of the woman, cover with a blanket, wait (even if the woman is hurt or even dead, just don't take the chance).

This means that, in the very common case of circulatory failure, if you wait for a patient to die, there will be no organ transplants available from that person. So in the usual case, the decision to harvest organs must be made before the brain fails, sometimes long before the brain fails. Can be hours before the brain fails in the case of internal bleeding.

In addition to that, a number of treatments that can work to save your life in the case of heart failure, such as lowering your body temperature by a lot, or simply operating on you for a few hours, will screw up any chance of successful transplants. Therefore, for donors they are not done.

Another thing that seriously lowers the chances of successful transplantation is using anaesthetics. It is not done. Organs are harvested without any kind of pain relief.

And also here's the difference between signing a donor card and not signing it. With a signed donor card, you are a donor. It's in the doctor's hands to take the decision to harvest your organs without any consultation (given the factors previously mentioned).

Without a signed card, doctors can still harvest your organs if either you or your next of kin agrees. Doctors will have to fairly explain the situation to you (if possible) or your next of kin, and then they get to make a decision, aware of the factors above. Needless to say, almost everybody says no.

Why ? At that time, "Yes" means certain death, and cessation of all medical efforts to save your life, "No" usually means 80-90% chance of death.

Example article on the subject : http://www.wsj.com/articles/SB100014240529702046030045772699...