Donate or do not?

Organ transplantation is the standard of care for patients with end-of-life organ failure.  A rapid increase in the number of patients requiring organ transplantation, without an increase in the number of organ donors, has resulted in long transplant waiting lists and a scenario where patients often die before receiving a transplant. Organ donation rates remain frustratingly low, despite encouragement for donation from governments, the public, and healthcare professionals. Efforts to increase organ donation have largely failed, due to a lack of theoretical framework and standardisation.  Expanding the scope of organ donation requires a multidisciplinary approach, grounded in ethics, considering the multitude of factors and stakeholders involved.  Evidence-based strategies involving legislation, education, donation co-ordinators, hospital committees, and population-based donor programmes have the potential to increase organ donation rates and eliminate the disconnect between organ supply and demand.