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The 105 pediatric deaths (ages 1 to 16 years) that occurred at Vanderbilt University Medical Center during a 31-month period were reviewed to define the size of the donor pool in the pediatric population and to assess the role of physicians in the procurement of these much-needed organs. Computerized discharge abstracts showed that 57 pediatric patients died without contraindications to organ donation. Manual review of these 57 medical records yielded 46 records suitable for review by Tennessee Donor Services. From this group, 19 eligible donors were identified. All eligible donors died from trauma, intracerebral hemorrhage, anoxic events, or hydrocephalus. Physicians failed to ask one family for permission to donate. All 18 of the families who were asked agreed to donate and organs were successfully procured from all 18 patients. These data suggest that families of pediatric patients are much more willing to agree to donation than the families of adult patients. As a result of this study, a simplified audit process has been developed for hospitals to use in evaluating compliance with required-request legislation.