The most aggressive approach, which is more than a default rule, is called routine removal. Under this regime, the state owns the rights to body parts of people who are dead or in certain hopeless conditions, and it can remove their organs without asking anyone's permission. Though it may sound grotesque, routine removal is not impossible to defend. In theory, it would save lives, and it would do so without intruding on anyone who has any prospect for life.

Although this approach is not used comprehensively by any state, many states do use the rule for corneas (which can be transplanted to give some blind patients sight). In some states, medical examiners performing autopsies are permitted to remove corneas without asking anyone's permission. Where this rule has been used, the supply of corneal transplants has increased dramatically. In Georgia, routine removal increased the number of corneal transplants from twenty-five in 1978 to more than one thousand in 1984. The widespread practice of routine removal of kidneys would undoubtedly prevent thousands of premature deaths, but many people would object to a law that allows government to take parts of people's bodies when they have not agreed, in advance to the taking. Such an approach violates a generally accepted principle, which is that within broad limits, individuals should be able to decide what is to be done with and to their bodies. (Page 177).