China faces a pronounced imbalance between the supply of and demand for organ transplantation， while the legal and ethical tensions become even more acute when organ donation involves minors. The current legal framework prohibits living organ donation by minors and strictly restricts guardians from being the proxy for post - mortem organ donation. However，in contexts such as being the only compatible match among immediate family members and when a minor’s genuine wishes are difficult to express，the existing system insufficiently addresses practical medical challenges. Adopting a comparative law perspective，this paper systematically reviews U.S. case law on organ donation involving minors. From the“substituted judgment” doctrine articulated in Strunk v. Strunk to the“best interests”standard developed in Curran v. Bosze，U.S. judicial practice has gradually shaped a dual-layered safeguard system that integrates substantive review with procedural control. Drawing on the valuable U.S. experience while remaining grounded in China’s national context，this paper proposes three avenues for improving the existing regime: refining informed consent mechanisms， strengthening procedural justice，and standardizing privacy governance and protection，aims to achieve a dynamic balance between life-saving needs and the protection of minors’rights and interests within a strict rule-of-law framework.