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We are writing to provide a commentary on the article titled, ‘Streamlining organ donation: impact of an artificial intelligence-based protocol post-brain death,’ published in BMJ Open Quality.1 The study’s focus on the use of artificial intelligence (AI) in the time-sensitive and ethically complex field of organ donation is highly relevant to current discussions in medical quality improvement. We commend the authors for their publication and for their candid admission that the AI protocol led to the unexpected outcome of increased delays. This finding highlights a crucial challenge that is globally relevant: why a seemingly beneficial intervention can have unintended consequences.