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It is time to consider an alternative approach to organ procurement and allocation -- one that relies on presumed consent to organ donation, combined with incentives which recognize the communal basis of the obligation to donate one's organs after death. Such a system must provide numerous opportunities for “opting out” of donation in order to promote individual autonomy and use economic and eleemosynary incentives for persons to contribute their organs after death. Mere mention of the words “presumed consent” and “compensated donation” may raise ethical eyebrows. However, a system of presumed consent to compensated organ donation should be considered as a rational response to the present organ shortage. We must view organ donation as an act of community service, and support it in the way that we currently encourage service in a volunteer military or the Peace Corps, with the provision of subsidized education, health, and other benefits to those who serve.