In Reply The Letter by Ms Perlman and colleagues makes 3 claims. First, it asserts that the End Kidney Deaths Act, which was developed by the Coalition to Modify NOTA (National Organ Transplant Act)—a group founded by Perlman and 3 other (uncompensated) nondirected kidney donors—is “a data-informed, ethically grounded proposal.” Second, their Letter argues that our concerns about the End Kidney Deaths Act “are speculative and lack empirical support.” However, we believe the authors’ claims are speculative, while our objections are based on observation and experience.