Today, more than 92,000 people await life-saving organ transplantations, and the gap between available organs and those in need of organs is progressively widening. For its part, the Joint Commission has continued to promote organ donation and cooperative organ procurement practices through its hospital accreditation standards. But this effort, like others, is falling short of the mark. No more than half of organs that could be transplanted are actually being harvested in hospitals. As is painfully obvious, complex issues underlie the failure of this nation to meet its organ donation objectives. The Organ Donation Roundtable has been charged to put forth recommendations for increasing organ donation, for improving equity in the process, and for protecting patients and donors. A national conference on organ donation, Health Care at the Crossroads: Organ Donation in the 21st Century was held in March 2004.