Organ donation in the United States is governed by state law through the Uniform Anatomical Gift Act (UAGA) based on gift law rather than informed consent principles (donation presents neither risks nor benefits to the deceased donor). This allows a legally binding transfer of a gifted organ from donor to recipient based on donative intent, transfer, and acceptance. The UAGA state laws align with US opt-in practices, in which permission is granted either by the donor in advance of death (such as designated on a driver’s license) or the donor’s surrogate at the time of death and affirmatively provides donative intent required for a legally valid gift that can be acted on. Over the past 5 years, the United States has experienced a 30% increase in deceased organ donors, from 8269 in 2013 to 10 722 in 2018,1 although the number or organs available for transplant still does not meet the increasing need.