There are no safeguards to ensure that such patients, when conscious, are competent to make donation decisions. There are no safeguards to ensure that such patients are not clinically depressed. There are no safeguards to ensure that members of the local OPO or primary health care team are trained to identify such depression. In fact, there are virtually no safeguards at all to ensure that the donation decision is voluntary. It is difficult to avoid the conclusion that such safeguards were thought unnecessary because such patients were considered more valuable when dead.