An independent review of Australia's organ donation program has found there is "significant room for improvement", highlighting "defensiveness" by the body responsible for improving the system.
The Ernst & Young review found stakeholders were concerned about the Organ and Tissue Authority's "tendency to limit debate about controversial issues".
It says the Authority's advisory council - previously chaired by TV presenter David Koch before his spectacular on-air resignation - does not provide any strategic oversight or performance monitoring and has recommended the government establish a board to govern the OTA to "foster a culture of debate".
It would then be a matter for the board to decide whether the advisory council would stay or go.
Mr Koch quit last May, accusing the minister responsible for organ donation, Fiona Nash, of caving in to a rich lobby group when she ordered the independent review.
Anne Cahill Lambert, who sat on the advisory council for five years, believes change is long overdue.
She quit in 2013 out of frustration that the council wasn't achieving anything, believing she could do more good for organ donation from the outside.
The authority and its advisory council started off strong in 2009 but needed to refresh itself after the first three years.
"We got to the next stage where it was clear to me that we had to do other things as well but the council was not asked to decide on things or to direct," she told AAP.
"It needed more than an advisory council to help drive that reform."
Ms Cahill Lambert says the council was hamstrung by its advisory role.
It wasn't allowed access to the Authority's budget and suggestions from the council were constantly brushed off, she said.
She described Mr Koch's on-air resignation as "more melodramatic than useful".
"There are so many people who need hope that this sector is working well, they don't need a tantrum on air."
The report says Australia's donor rate has increased by 41 per cent since the national reform program was implemented in 2009 but there is "still significant room for improvement of donation rates going forward".
Australia's donor rate sits at 16.1 dpmp (number of deceased donors per million population) - well short of the 2018 target of 25 donors per million.
The report makes 24 recommendations, including that the Authority publish donation rates by state and consider publishing the donation performance of individual hospitals.
Senator Nash said work was already underway to implement some of the recommendations, announcing on Tuesday an overhaul of the organ donation registration system, after the report found 4.3 million people signalled an intent to become a donor but failed to follow through with the paperwork.
From May, would-be donors will be able to register their consent online in less than ten minutes.
