Organ donation in Australia is way behind the world leaders, according to international rankings that put the country in 21st place.
Spain is the world leader, and France, the US, UK, Belgium and Norway are among the countries with higher proportions of donors than Australia.
The figures compiled by Sharelife Australia draw on international donor data published by the Council of Europe.
The data shows hundreds of Australians are missing out on life-saving transplants every year.
This is because a $151 million, four-year package announced by the federal government in 2008 has failed to achieve its goal of establishing Australia as a world leader.
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There has been an improvement, says ShareLife spokesperson Sara Irvine, but Australia's progress is slower than many other countries.
Australia's rate of organ donation is half that of the leading countries, and 1000 more transplants could be performed a year if it reaches the level of the top five countries.
"We are still not in the top 20 nations and have long way to go," says ShareLife director Professor Allan Glanville, medical director of lung transplantation at St Vincent's Hospital in Sydney.
"Organ donation saves lives, saves money and improves quality of life.
"You only need to talk to people who have been on kidney dialysis to see how well and productive they are after a kidney transplant.
"The Spanish model is very compassionate. It is supportive of families."
Family consent is needed, even if a person has opted in as a donor.
In Spain, skilled organ donation specialists speak to family members, which improves the chances of donation.
"They support families through what is an awful process."
Prof Glanville says there are good people doing good work in Australia.
"But we need to tweak the system so we are consistent from state to state."
He questions why South Australia and Victoria have 20 deceased organ donors per million of the population and NSW has 14.
"Australia needs to increase to 30 per million to be in line with the top four or five countries.
"Change takes time, but unless we improve we are failing in our duty of care to our patients.
"I have patients who are waiting for transplants and if they don't get a transplant they may well die."
