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A structural econometric study of four US organ procurement organizations (OPOs) covering 35,856 potential donors between 2016 and 2021 finds that organs were recovered from only 39% of transplantable donors. Researchers identify that 16% of missed donation opportunities stem from conservative OPO preferences and 12% from miscalibrated probability estimates, with the remainder due to family declines. Counterfactual modeling suggests that increasing approach rates could recover organs from 43% mo