The decision to donate organs after death is highly personal and complex. It is intertwined with medical, legal, religious, cultural, and ethical issues. One person’s decision represents the only chance of survival for someone else as organ donation is the only cure available for many children with end organ failure. Many of these patients will die because there are more people waiting for a lifesaving transplant than there are organs available. It is therefore vital that clinical teams involved in the care of children who have reached the end of their lives are familiar with the identification of potential donors, the diagnosis of death within the critical care setting, the collaborative approach to the management of end-of-life care and consent to donation. Consequently, understanding the deceased donation process and the issues that may interrupt and prevent donation is paramount in ensuring that this scarce resource is used effectively in line with the wishes of potential donors for the benefit of potential recipients.