Graeme Laurie and the late Ken Mason once commented that the Human Tissue Act 2004 had been ‘born under the wrong star’. Alas, ‘baleful stars’ have often blighted this area of medicine, and this chapter reflects on the past in order to consider the prospects of success for new legislation across the United Kingdom introducing ‘deemed consent’ for deceased organ donation. It outlines how a legacy of fear and distrust beset the uses of human corpses, from the ‘anatomical renaissance’ and the donation by the Kings of Scotland and England of the bodies of executed criminals for dissection to the enactment of the Human Tissue Act 2004 and the Human Tissue (Scotland) Act 2006 in the wake of public outrage over non-consensual organ retention for research and teaching. It argues that, whatever the letter of the law, grieving families cannot be ignored. A supportive, well-organised transplant system in hospitals at the point of death is as crucial as debates about the pros and cons of opt-in or opt-out. How the new legislative frameworks for donation are implemented in practice will be as important as the words in the statute-books.