Background: The shortage of organs for transplant In Europe has been considerable for many years. A number of different policies have been implemented in an attempt to address this problem. These have had varying degrees of success from country to country. Methods: This article provides an up-to-date review of organ procurement policies throughout Europe. Alternative and In some cases controversial organ procurement programmes are also considered to establish whether the increasing demand for organs can be met elsewhere. Results: Transplant waiting lists are the greatest by far for those patients waiting for a kidney replacement. Norway has best managed to address this need through adopting a positive policy choice towards live donation whilst still maintaining an active cadaveric donation policy. Conclusion: With the lowering of both physical and social barriers In Europe, there has been a recent shift towards co-operation between some European countries in promoting transplant activity. This ensures that if an organ becomes available in one country and has no suitable recipient, then it can be used elsewhere. The future may show and increasing trend towards this level of European cooperation in order to make transplant activity more efficient.