The donation of organs and tissues for the benefit of another person is an altruistic act and one that is a guaranteed option for the next-of-kin through various national Required Request legislations. At the Washington Hospital Center we have developed an approach that permits organ recovery from non-heart beating donors. The focus is on victims of fatal trauma and assures that each family is empowered with the right to make a donation decision. In October 1993 a consensus conference was held on implementing a program to recover organs from fatal trauma victims. The participants recommended that safeguards be incorporated to assure ethical treatment of both the trauma victim and the next-of-kin. An Office of Decedent Affairs (ODA) was then established and implemented in September 1994. The ODA is staffed by Family Advocates who are on duty continuously and respond to all trauma and death events. Their mission is to consolidate all death events, provide support to decedent families, assure that required request mandates are fulfilled, interact with the local Organ Procurement Organization (OPO) in the consent process, and facilitate the implementation of the Rapid Organ Recovery Program (RORP). The RORP consists of two specific procedures: cannulation of the femoral arterial-venous system for flushing the kidneys with a preservative solution, and intubation of the peritoneum for in situ cooling using an ice/lavage process. In the 1-yr period since the ODA was established, organ and tissue donation has increased by more than 300%.