Objective. To identify factors that influence parents' decisions when asked to donate a deceased child's organs. Design: Cross-sectional design with data collection via structured telephone interviews. Setting: One organ procurement organization in the Southeastern United States. Participants: Seventy-four parents (49 donors, 25 nondonors) of donor-eligible deceased children who were previously approached by coordinators from one organ procurement organization in the southeastern United States. Interventions: None. Measurements and Main Results: Multivariate analyses showed that organ donation was more likely when the parent was a registered organ donor (odds ratio [OR] = 1.4, confidence interval [cl] 1.1, 2.7), the parent had favorable organ donation beliefs (OR = 5.5, Cl = 2.7, 12.3), the parent was exposed to organ donation information before the child's death (OR = 2.6, Cl = 1.7,10.3), a member of the child's healthcare team first mentioned organ donation (OR = 1.4, Cl = 1.2, 3.7), the requestor was perceived as sensitive to the family's needs (OR = 0.4, Cl 0.2, 0.7), the family had sufficient time to discuss donation (OR 5.2, Cl = 1.4, 11.6), and family members were in agreement about donation (OR = 2.8, Cl = 1.3, 5.2). Conclusions. This study identifies several modifiable variables that influence the donation decision-making process for parents. Strategies to facilitate targeted organ donation education and higher consent rates are discussed.