because of the 1998 medicare law, anyone, regardless of whether they signed or not, is subject to their family being approached, this is to stimulate “organ donation”
any hospital that accepts medicare funds, must call the local, federally designated “organ donor” business, and let them know that they have a prospect, the hospital must report to the “donor agency” and the “donor agency” keeps tabs on the prospect
if it looks good (a good specimen) the donor agency will approach the family, organ donor card or not
Families will be approached by a member of a trained hospital team, not the procurement organization. The donor agency keeps “tabs” only in the sense that time is of the essence and often they must move fast if the family wants to donate. Usually the team must fly in unless the potential donor happens to be in a city with a procurement team.