Australia has one of the worst organ donation rates in the western world. The consequence of this is that the waiting list for life-saving transplants is increasing. Australia has a highly successful transplant programme, but a limited number of organs are donated. Unfortunately, Aboriginal people are over-represented in the organ-failure patient group - particularly in end-stage renal disease. Renal transplantation has the potential to improve quantity and quality of life for Aboriginal people with renal failure. Aboriginal people have a right to be given the same opportunities as non-indigenous people to donate their organs at the end of life and improve the transplantation rates among their own people. The most effective way to improve indigenous donation rates will be through improving the knowledge of Aboriginal people about organ donation. There are cultural complexities and end-of-life rituals that make the decision to donate organs difficult, but these issues do not preclude a family from making the decision to donate organs at the end of life. We need to provide Aboriginal communities with appropriately presented information to give them a basis for making an informed decision about organ donation. Equity of access is important. Cultural competence of requestors is important. Consultation, communication and education are the way forward.