A simulation-based education programme was created to help clinicians in New South Wales (NSW) lead difficult conversations about organ and tissue donation (OTD) with the families of dead or dying patients. Participants led a planning meeting with the Intensive Care Unit (ICU) team, then a family donation conversation (FDC) with the family of the potential donor. Professional actors played family members during scenarios based on real cases. A three-stage debriefing process including video-reflexive feedback followed the FDC. Eighty participants completed the training, which was universally well received, with participants reporting a wide range of educational benefits and increased confidence. There has been an increase in the family consent rate for OTD in NSW over the duration of the programme. Whether the training contributed to this increase is unclear at this stage.