Objective-To identify factors that influence parents' decisions when asked to donate a deceased child's organs.Design-Cross-sectional design with data collection via structured telephone interviews.Setting and Participants-Seventy-four parents (49 donors, 25 non-donors) of donor-eligible deceased children who were previously approached by coordinators from one organ procurement organization (OPO) in the southeastern USA.Main Results-Multivariate analyses showed that organ donation was more likely when the parent was a registered organ donor (OR=1.4, CI=1.1, 2.7), the parent had favorable organ donation beliefs (OR=5.5, CI=2.7, 12.3), the parent was exposed to organ donation information prior to the child's death (OR = 2.6, CI = 1.7, 10.3), a member of the child's healthcare team first mentioned organ donation (OR=1.4, CI=1.2, 3.7), the requestor was perceived as sensitive to the family's needs (OR=0.4, CI=0.2, 0.7), the family had sufficient time to discuss donation (OR=5.2, CI=1.4, 11.6), and family members were in agreement about donation (OR=2.8, CI=1.3, 5.2).Conclusions-This study identifies several modifiable variables that influence the donation decision-making process for parents. Strategies to facilitate targeted organ donation education and higher consent rates are discussed.