Organ transplantation is the most effective treatment for end-stage organ failure and is a much sought-after therapy. Efforts are under way to maximise the number of families who agree to organ donation on behalf of a newly deceased relative in Australia, with the hope of easing the burden for dying and incapacitated patients and to reduce health care costs. Objective: To present initial findings from a study which asked families who had been required to make a deceased organ donation decision about their experience, and the factors that contributed to their decision to either agree to or decline organ donation. Methods: Following ethics approval, an exploratory multiple case study was conducted. Twenty-two family members from nine families who had experienced the death of a relative within the previous three years from five of Australia's state and territories contributed to the study in 17 recorded, transcribed and analysed interviews. Findings: Broad themes emerged that included the importance of time and location, perceptions of suffering, information and help for the families, and the need for families to assure themselves that the deceased's needs were addressed before and after death. Conclusion: The findings suggest families require trust that their family member was not suffering before and after death. The affirmation of this trust was helped by prior information about the organ donation process and sensory affirmation that their loved one was at peace. Family decisions about organ donation, hopes and 'deep hopes' were dependent on this trust.