Motor vehicle (MV) clerks are at the epicenter of organ donor registration. We show that MV clerks (n = 225) in two northeastern states have knowledge gaps and negative beliefs about organ donation. A majority believe it may be possible to buy organs on the black market (81%) and that recovery from brain death is possible (65%), whereas nearly half believe that doctors might not work as hard to save the life of a registered donor (46%). Organ procurement organizations should conduct formal educational programming with MV staff, considering their prominent role in the donor registration process.