Since family permission is necessary for organ procurement to occur in China, family discussions about posthumous organ donation are crucial for increasing the actual organ donation and transplant rate. However, this study found that among 298 Chinese young adults, most of them (88%) were reluctant to talk about organ donation with their families. Based on the Theory of Reasoned Action, this study investigated communication within families about organ donation. Psychological factors included intention, attitude, subjective norm, death anxiety, and knowledge. As expected, the subjective norm was more powerful than attitude in explaining family discussions among Chinese people. Death anxiety, but not misconception, also significantly lowered the likelihood of family discussion. It is concluded that future campaigns for lessening death anxiety and promoting the social norm for organ donation must be conducted in Chinese societies, in order to encourage family discussions and improve the donation rate. © 2008 Taylor & Francis.