Organ donation is often an emotive subject. However, research from the NHS blood and transplantation service suggests 90% of the UK population support organ donation, with only 33% of the population on the NHS Organ donation register. Worryingly the number of patients on the active Heart Transplant waiting list has increased by 143% since 2006 whilst at the same time numbers of heart transplants are falling – in 2014/5 there was a 16% reduction in adult heart transplants compared to the year previously. This month has seen Wales become the first country within the UK to introduce presumed consent for organ donation as a mechanism to reverse this imbalance. In a situation where organ donation can be considered, if the person has lived in wales for longer than 12 months and there is no express wish to opt out and revoke consent, organ donation can take place. This has long been the practice in other European countries such as Belgium which, following the introduction of similar legislation, saw a doubling of organ donation rates. The Welsh example will hopefully give the devolved administration of Northern Ireland the confidence to follow suit.