Although everywhere managed through gift exchange, the legal procurement of human organs in Western countries is institutionalized in different ways. In particular, law in some countries allows for the consent of the donor to be presumed (absent a recorded decision to “opt-out”) while others require that prospective donors “opt-in.” More broadly, donor procurement takes place within health systems which institutionalize different relationships between the individual, the medical profession and the state. Using time-series data from sixteen OECD countries, I investigate variation in procurement rates. Countries with presumed consent laws are found to have higher procurement rates. Evidence from case-studies strongly suggests that presumed-consent legislation may be a marker for other organizational practices. Welfare state regimes are found to have weaker but notable effects, suggesting a link between varieties of welfare capitalism and the growing world of organ and tissue harvesting.