I understand why people are reluctant. If you donate your organs, you don't get a 'death'—as in your loved ones don't get to sit and hold your hands while you die—as you need to be kept 'alive' while the organs are removed. You die on the operating theatre table.
Another issue (the one that worries me) is that anaesthesia isn't always given, but neuromuscular block is, to stop the spinal reflex movements.
>Spinal reflex movements are common and full neuromuscular block is required. Hypertension and increased plasma catecholamine concentrations have been observed during surgery and attributed to spinal reflexes. These can occur spontaneously or on surgical stimulus and have prompted some to suggest that anaesthesia for organ donors is required.
I can't edit my post. You are right. I see bills pending to make it opt-out rather than opt-in, but I was totally mistaken. After researching this for a while after seeing your reply I can not find any states currently doing opt-out.