A simple separation of concerns could solve a portion of the ethical and pragmatic problems people have brought up in this discussion. The treating doctor does

A simple separation of concerns could solve a portion of the ethical and pragmatic problems people have brought up in this discussion. The treating doctor does not get to know the donor status of the patient and has nothing to do with extracting the organs once the patient is either dead or "dead enough". The doctor reports on the patients chances of survival/waking up etc and this is checked against the patients donor status including any permission to harvest organs if there's no or only a tiny chance of survival. Of course there's a number of hypothetical situations where this falls apart - if there's only one qualified doctor available in a tiny hospital or if there's no access to patient records/pre-recorded desires. However, it's a place to start. Until there are better options available or a series of well publicized abuses I will continue to be an organ donor because, to put it simply, the golden rule.