The recent Task Force document regarding organ donation in the UK should raise concerns amongst paediatricians. Whilst the document should act as a clarion call to the NHS to facilitate the provision of organs from dead donors, and either save or improve the quality of the lives of those in irreversible organ failure, there is no mention in the document of donation in the child population. Unfortunately this is not because the impasse in adult donation is unknown in paediatrics, but perhaps hints at the even greater efforts that significant changes in paediatric organ donor rates will require. Can we, however, seize the opportunity afforded by the focus on donation that the Task Force will generate to improve the situation in regards to children? This review cannot address all aspects of donation but will highlight areas in which there may be opportunities to optimize provision of organs to severely ill and dying children.