Many transplant programs are willing to provide a contrived medical excuse for potential organ donors who wish to say no but feel unable to do so publicly. The availability of these excuses is thought to facilitate freedom of choice—a necessary component of informed consent—by allowing donor candidates to bow out gracefully. In a recent editorial, Simmerling et al. discuss possible harms raised by this practice and note that there is no empirical evidence to support it. Given the importance of this issue for transplant centers that accept living donors, a review of the authors' concerns is in order. After careful consideration, I conclude that although some of their points are valid, much of their analysis is flawed.