We review various organ procurement strategies from ethical and practical perspectives to understand why these strategies have been relatively unsuccessful. We propose that the CMA recommend the implementation of a required-request policy in hospitals. We also propose a possible new approach in which people from the age of 18 years would voluntarily enrol in an organ donation program, agreeing to permit all usable organs to be taken for transplantation at the time of death. In return they would have priority for receiving organs made available by the program. We believe that this program would save lives, respect the donor's autonomy and satisfy the principles of justice and beneficence.