Organ donation is a complex and sensitive area. It is complicated by ethical, legal and social factors, as well as differing views about consent. Although organ donation rates have risen, there continues to be a significant gap between organ supply and demand. Despite previous calls for a change to the opt-in consent system used in England, and the move towards presumed or opt-out consent in Wales, the Organ Donation Taskforce rejected any such policy change in England, in favour of improving the infrastructure and systems surrounding organ donation. This article examines the various systems of consent for organ donation and strategies for improving organ donation rates.