The Harris County Medical Examiner's Office (HCME) is proactive and supportive with regard to organ and tissue donation. Steps taken to facilitate donation include development of standardized multiagency protocols for organ/tissue requests and transfer of decedents out of the facility for tissue recovery prior to autopsy. The organ/tissue agencies have 24-hour access to a liaison staff member. No blanket denials are issued for any case type; instead each case is evaluated for feasibility of donation. In rare instances donation of one or more organs is considered detrimental to the mission of determining cause and manner of death. In these cases, the HCME requests that specific organ(s) not be recovered. In this jurisdiction, the organ procurement organization often proceeds with organ recovery despite medical examiner objection. In such cases, the autopsy examination is incomplete and the cause of death cannot be determined. A series of 5 organ donation cases are presented for illustration. Four of these cases are infant deaths in which the HCME requested specific organs not be donated. In the fifth case no denial was issued, but release was granted on incomplete or erroneous information. The cause and manner of death in each case remains undetermined.