The issue of organ donation by minors has long been a focal point of legal and ethical debate. In the United States, case law has established mechanisms of individual case review and judicial intervention, allowing limited donations by minors under exceptional and strictly regulated circumstances. In contrast, Chinese law explicitly requires living donors to possess full civil capacity, thereby excluding minors from such donations at the institutional level. However, practical challenges remain regarding procedural clarity, ethical review, and the boundaries of guardianship. From a cross-jurisdictional perspective, this study argues that China should draw on the U.S. experience with case-specific judicial review, while taking into account its own legal traditions and cultural context, to construct a minor organ donation protection system centered on the “best interests of the child,” balancing legality, scientific rationality, and humanistic care.