From 1981 to 1985, a total of 46 cases of hypoplastic left heart syndrome were diagnosed in Kentucky hospitals. During the same period, there were 64 live births of anencephalic neonates in Kentucky, half of whom were of adequate size for organ donation. Philosophic and pragmatic discussions among physicians, ethicists, and legislators must take place if organ donation by anencephalic subjects is to be used to ease the growing demand.