During the past 25 years the results of organ transplantation have improved continuously. The steadily growing success of organ transplantation is only hampered by the lack of available donor organs. Despite the efforts to increase donation rates in all European countries, only Spain has experienced a notable increase. Of particular importance is that about 1/3 of organ donors in Spain are detected in small hospitals without a transplant unit. Organ donation rates in Spain, Eurotransplant, the United States, and Turkey are 33.5 per million population (pmp), 14.2 pmp, 21.2 pmp, and 0.77 (0.5-1.5) pmp, respectively. There is no transplant centre in Denizli. Forty brain-dead patients and 11 actual donors were investigated retrospectively. The family refusal rate was 58% (18/31) and medical contraindication for organ donation was 22.5% (9/40). Our cadaveric donor rate is 2.4-4.7 pmp, which is higher than the average of Turkey (0.77 pmp). Organ shortage is not due to a lack of potential donors, but rather to a failure to turn many potential ones into actual donors.