Background How to approach and obtain consent from the family of the deceased for organ donation remains a matter of controversy. This has resulted in the absence of a structured pathway and suboptimal consent rates world-wide. Despite limitations stemming from cultural, ethical and legal differences in different regions, there can be general recommendations to improve consent rates regardless. The present study aimed to provide a structured pathway while approaching families of the deceased for consent. 
Methods In the present quality improvement project 82 hospitals in Tehran, the capital province of Iran, were included. Data regarding the consent rates between April 2010-March 2011 were collected. After establishing the baseline, the unsuccessful attempts for consent were identified and sessions were held for investigating the causes for the rejection of organ donation. The initial meeting between the coordinator and the family that rejected consent was reconstructed through role-playing. Learned lessons were implemented in the manuals of coordinators through Plan, Do, Study, Act (PDSA) cycles.
Results & Discussion The baseline yearly consent rate was 31.2%. The consent rate during the final year of the project reached 96.3%. The 10 key points that contributed the most to the increased rates of consent were detected through PDSA cycles and are summarized in table 1.  

Conclusion The 10 recommendations of the present study, summarized in table 1 can serve as a guideline for improving the consent rate of the families of the deceased to organ donation.