The global shortage of organs for transplantation is a critical public health issue, leading many countries to reassess their organ donation policies. In the Philippines, organ donation rates remain significantly low under the current optin system, where individuals must actively declare their consent to donate. This perspective examines the challenges and limitations of the opt-in system in the Philippines, considering cultural, operational, legal, and ethical factors. It also discusses the emergence and effectiveness of the opt-out system, where consent is presumed unless explicitly denied, and evaluates its potential applicability in the Philippine context. Drawing on international experiences and evidence, this paper argues that transitioning to an opt-out system—supported by appropriate legislation, infrastructure enhancements, and culturally sensitive public education—can significantly increase organ donation rates in the Philippines and better address the nation’s organ shortage.