Multiple groups, including the National Bioethics Advisory Commission, the American Society of Clinical Oncology (ASCO), the National Coalition of Comprehensive Cancer Centers (Personal communication with Robert B. Catalano, PharmD, Vice President for Regulatory Affairs, Coalition of National Cancer Cooperative Groups), Workgroup 6 of the Summit Series on Cancer, PRIM&R, the Bell Report, and prominent ethicists have called for replacing the current system of local institutional review with central review for multisite national trials. We argue that this need is particularly acute in pediatric oncology, as shown by the experience of the Children's Oncology Group (COG).