Six in 10 families refused to donate an eligible loved one's organs last year, the highest rejection rate in the world according to one campaigner.
Organ donation was possible for 367 deaths last year according to GiveLife NZ but organ donation was only discussed with the family in 135 instances, or 37 per cent of the time.
The number of remaining potential donors shrinks further when families have their say with 61 per cent saying no.
Overall, there were just 53 donors in New Zealand in 2015.
In order for an organ donation to be possible, two separate sets of brain death assessments need to be carried out by doctors.
Organ donation is then discussed with the family.
"It turns out that three of the 53 donors didn't actually donate any organs to anyone so the figures are massaged upwards to make a very, very poor system look like just a very poor system," organ donation campaigner Andy Tookey said.
"It must be clearly understood: New Zealand will never have a world-class donation and transplantation service if more than six out of every 10 families say no to donation."
New Zealand is in the lower half of organ donors according to the international registry of organ donation and transplantation IRODaT.