There are about 65 transplant co-ordinators in the UK, but funding is uneven - even though trusts gain financially from doing transplants.

Dear Mummy', reads the poster drawn by eight-year-old Chloe Gee, 'when I don't need my heart any more, please may you give it to someone who does need it?'

Emotive stuff. It is all part of the national organ donor campaign. The government wants to raise awareness of the need not just to be a donor, but to tell relatives and loved ones who take the decision after you die.

Twenty-six per cent of requests for organ donation are turned down by relatives, often because they don't know the dead person's wishes. Carrying a donor card, or being on the NHS Organ Donor Register, is not enough - even though, from its launch in October 1994 to the end of 1997, 4.67 million people registered for the scheme.

While a publicity campaign like this can help, it can only do so much. Few people die in circumstances which mean they can be donors. Because organs are held in a kind of suspended animation before transplant, the donor has to have died in intensive care, and then only once declared brain-stem dead.

Someone seriously injured in a road crash may not even make it to intensive care, or may be placed in a medical ward if doctors know there is nothing they can do to save them.

While Spain's organ donor rate is 22 per million, the UK's is only 14. 'But that is because their road traffic accidents are twice ours,' says Vanessa Morgan, chair of the UK Transplants Co-ordinators' Association. 'And they have four times the number of intensive therapy unit beds, so they admit everybody. We just don't.'

Medical and nursing staff may not feel able to ask the relatives' consent for donation at a harrowing time. They need to be trained to handle the situation and to handle the donation process.

As this year's report from the United Kingdom Transplant Support Service Authority shows, we seem to have reached a plateau in donations - 900 donors gave 3,035 organs in 1997 for the UK and Republic of Ireland. This was five more than the previous year, and included an increase of 14 in Ireland.

And transplants of organs like kidneys, from live donors, are failing to keep pace with waiting lists. Though 197 donors gave their organs in 1997, waiting lists rose by 3.3 per cent on the previous year. There are, though, pockets of achievement around the country - Newcastle, for example - raising the question of why some trusts seem to have cracked it, while others have not.

It is the job of around 65 transplant co-ordinators around the country to try to encourage more organ donation. They are not a centrally governed service, so funding varies. Some are funded from a transplant programme, others by the purchasing authority, while others are still paid by drug companies, says Ms Morgan.

They also have a wide remit: from giving talks to trainee doctors and nurses, to contact with ITU staff, to counselling the donor's family.

North Thames, where she works, has six co-ordinators and runs an on-call system, for which staff are paid. But it is not like that everywhere.

'Last week I had been on duty all day, then at quarter to eleven that night the bleep went off,' says Ms Morgan. 'I had to drive to Chelmsford, and was there until three the next afternoon. I'm paid for that, but some people aren't.'

Not all areas can justify having a 24-hour on-call service and inevitably lose potential donors. 'In somewhere like Coventry they have five trauma units, but they can't employ three co-ordinators, which is what you need for an on-call service.

'You are also employed to look after renal patients, but then you can't be out teaching about organ donation as well.' Pressure on ITU beds causes problems, too: 'If they are busy and haven't got any beds left in ITU, it is easier just to switch off.'

It can take anything from five to 10 hours from brain-stem death being diagnosed to the donor going into theatre - time which could be used to save someone else if the unit is busy.

Aberdeen is the only place in the country without a co-ordinator, yet its Royal Infirmary still managed to get 11 organ donors in 1997 - better than many other places.

As for Newcastle's success - 28 donors in 1997 - Ms Morgan says it is difficult to identify the factors responsible: 'One reason is most of the donors come from one neurological unit. It helps if you have a centre which is highly motivated. Most district general hospitals will only see a brain- stem death once or twice a year.'

Pam Buckley, a former nursing sister, is senior transplant co-ordinator for the former Northern region, including Newcastle General. She puts it down partly to public support.

An awareness campaign with the Newcastle Evening Chronicle has helped. And when TV shows like Casualty cover the issue, it makes their job easier.

Both she and Ms Morgan feel they are often forgotten by managers. 'They don't appreciate what our job is about,' says Ms Buckley. 'The trust gets cash from doing transplants. There is no appreciation of the importance of organ procurement.'

Spending money on more co-ordinators, training, or a national framework for them might help, and running a publicity campaign is probably as cost- effective as anything. 'But the most scarce resource in all this is the organ,' says Ms Buckley.