The legal concept of First Person Authorization (FPA) is based on the principle that a decision by a person with decision-making capacity should be respected even after he or she dies. Although the transplant community largely supports this concept, its implementation has not been universal. We conducted a web-based survey of all 58 OPO executive directors in the U.S. to assess OPOs’ procurement policies and practices in the context of family objections. All 58 respondents (100%) responded to our survey. All OPOs except one have an online donor registration website. Most OPOs (89%) (51 of 57 respondents) estimated that the frequency of family objecting to organ donation in cases of registered donors was < 10%. No OPOs reported the frequency to be higher than 25%. Only 50% (27 of 54) of the OPOs have a written policy on handling family objections. Approximately 80% of the OPOs reported honoring FPA. However, in the past 5 years, 20 OPOs (35%) have not yet participated in organ procurement from a registered deceased donor over family objection. Further research to identify the barriers and possible solutions to implementing FPA is warranted.