Video report by ITV News' Peter Smith
The number of people donating organs has fallen for the first time in more than 10 years - prompting urgent calls for more people to join the register.
There has been no increase in the rate at which people sign up to donate organs, while fewer people are dying in circumstances under which they could donate.
4,431 transplants took place in 2014/15 - a fall of 224, or 5%, on 2013/14, according to official figures.
NHS Blood and Transplant, which published the figures and leads organ donation across the UK, is now asking the public to help shift the dial.
Its report said that a revolution is required in attitudes to organ donation, and that people waiting for a transplant will continue to die needlessly. Families are much more likely to agree to donation if they know it is what their loved one wanted.
"We have always known that because the opportunities to donate are so small, it is essential to increase the number of people who say yes to organ donation," said Sally Johnson, NHS Blood and Transplant's director of organ donation and transplantation.
"If the pool of potential donors is reduced then this is even more important.
"We understand that families are expected to consider donation in their darkest hour so we would remind everyone to tell those closest to you now if you want to donate your organs - and then record that decision on the NHS Organ Donor Register.
"Should the time come, your family will know you want to donate your organs to help to save others."
To join the NHS Organ Donor Register visit www.organdonation.nhs.uk or call 0300 123 2323.