The ability to transplant organs and other tissue to patients has dramatically transformed the life expectancy and quality of life of many patients. An increasing range of procedures has now become possible, from heart transplants to ‘face’ transplants. The success of such procedures brings with it an ever-increasing demand for organs and tissue and, inevitably, a shortage. At the time of writing, more than 5,000 people are currently waiting for a transplant in the UK. Understandably, this has led to continual challenges to the legal and ethical boundaries of what is permissible. Animal organs and tissue may in some circumstances be used and in principle such procedures may be considered as similar to more routine forms of medical treatment and raise the same issues of consent and propriety. Accordingly, no separate consideration is given to those issues in this chapter. Organs and tissues obtained from human beings, whether living or dead, raise special issues which are considered here. These issues principally concern the means by which organs and tissue are obtained. They cross the boundaries of life and death. Thus the use of organs taken from a dead person may be governed by decisions made by that person before their death. Questions may arise as to what may or should be done to prepare a donor’s organs for donation in anticipation of death. After death, the use of organs may be governed by the decisions of those appointed by the deceased to deal with the issue of consent, and disputes may occur as to the storage and use of organs or tissue. Above all, there is a need for as much legal clarity as possible so that doctors, other medical staff, potential donors and their families can feel confident in the process. Failing this, there is a danger that the supply of tissues and organs will diminish rather than increase. This chapter looks specifically at the legal requirements for organ donation and transplantation in England. The principal legislation, the Human Tissue Act 2004, also governs the donation and use of human tissue for other purposes, such as research and anatomical display, but these are beyond the scope of this book. Necessarily this chapter focuses on the process of organ donation, as the transplant of organs and tissue into a recipient is covered by the general legal principles governing consent to medical treatment dealt with elsewhere in this book.