This service evaluation assesses the frequency of emergency nurse initiation of discussion about tissue donation with suddenly bereaved relatives. Data was retrieved from one accident and emergency department (A&E) in the North of England between January 2006 and December 2007. It is clear from the service evaluation that insufficient initiation of discussion occurs and a range of reasons for non-initiation are identified. Of concern here, non-initiation impacts on the potential number of people in the United Kingdom who could benefit by sustaining life or improving quality of life and nurses need to be encouraged to provide choices for the donor, their family and the recipient. Further, the findings have implications for training, mentoring and supervising emergency nurses, application of a written policy and scope for future research.