In my own state (of residence) they usually remember to ask when you get a new drivers license whether you want them to check the box that says you wish to donate your parts and pieces. Unfortunately, it has been held that this does not constitute a "binding" certification, unless signed and witnessed appropriately. Since they laminate the license before you get it, it's impossible to fill in the blanks that are there, so as a practical matter, the driver's license endorsement can never be a "completed instruction."

The result is that you can only consider the endorsement on your license as a "suggestion that they look for" a valid and enforceable declaration in some other form, usually in a will or, as mentioned above, an "Advance Directive," properly prepared. A will is NOT generally a good place to put such instructions, since it may be "sealed pending probate," or otherwise tied up, and not available when the instructions are needed.

Few people actually get around to preparing, and making known, the necessary "real permissions."

A fairly high percentage of people here have had the donor box checked on their driver's licenses, and happily believe that their leftover parts will be put to use. Sadly, in the great majority of cases, they will not be. The cases in which donor organs are actually used come mainly from permission given by a surviving spouse or parent, either of which is usually "presumed" to be able to speak for a deceased person "in the absence of documented intent of the deceased."

John