The UK government and NHS Blood and Transplant have introduced a number of policies and organisational changes to the organ donation system following the 2008 recommendations of the Organ Donor Taskforce, which aim to increase the number of available donor organs and tackle transplant waiting lists. However, little is known about how these policy and organisational shifts influence how healthcare professionals experience delivering end of life care in the context of organ donation. In this paper, we examine ICU, Emergency Medicine, and Theatre staff’s experiences of organ donation in one NHS Trust following the 2008 changes. We focus upon their decision-making when caring for patients at the end of life to highlight the tensions between health professionals' beliefs-in-principle about organ donation and their everyday moral and commonsense practices when caring for patients at the end of life. We explore how we might understand and interpret this ‘troubling’ of organ donation through applying the concept of ‘conscience’, and consider whether a conscientious objection around organ donation could exist.