  A number of controversial issues in biomedical ethics concern how public policy could, and should, change if obligations of social beneficence were given more strength in policy formulation than they have traditionally been afforded. The foundations of public policy regarding organ procurement provide an instructive example. Established legal and policy precedents in many countries require express consent by a decedent before death or by the family after death. A near absolute right of autonomy to decide about the disposition of organs and tissues has been the prevailing norm. However, this approach impairs the efficient collection of needed tissues and organs, and many people die as a result of the shortage of organs. The scarcity of organs and tissues and the inefficiency of the system have prompted a spate of proposals for reform of the current system of procurement, with the goal of creating more space for social beneficence.