Just one-in-three people in Northern Ireland have signed up to become organ donors.
Despite a transplant waiting list of 190 people and up to 15 deaths-a-year, only 31% of the population has joined the NHS organ donor register.
Dr Eddie Rooney chief executive of the Public Health Agency (PHA) warned: "In Northern Ireland almost 200 people are currently waiting for a transplant and sadly the chance will come too late for many."
Last year, 123 transplant operations were carried out in hospitals across Northern Ireland. However, the level of demand has hit an all-time high, having jumped by 40% since 2001.
By becoming an organ donor one person can help save or significantly enhance the lives of nine others.
Dr Rooney, who also chairs the Northern Ireland committee for organ donation and transplantation, added: "Organ donation really is the gift of life. The generosity of donors and their families enhances or saves the lives of recipients across Northern Ireland."
General support for the concept of organ donation for transplantation is high (84%) and the majority of people (78%) said they would take an organ if they needed one.
But even though the number of names on the register has increased in recent years, more than a third of families have refused to give consent to the donation of their loved one's organs.
They cited spiritual beliefs, medical distrust and the so-called 'ick factor' over having body parts removed among the main reasons for their opposition.
Of those wishing to donate their organs after death, only 38% had discussed their wishes with family members.
And, despite a massive publicity drive by the Department of Health, around a third (36%) did not know about the organ donor register, with awareness particularly low among the 16-to-29-year-olds and the over 65s.
Around 56% said they would favour changing to an opt-out/presumed consent system – currently being considered by the Assembly – while 18% were opposed to any law change.
The findings are in a new report on public attitudes towards organ donation and transplantation carried out by the PHA.