Fewer than one in five people in Birmingham are on the NHS Organ Donor Register.
With 250 patients in the city needing transplants, Birmingham has the second-longest waiting list but, at just 18 per cent, one of the lowest number of potential donors.
Now a new campaign has been launched to improve the figures.
The initiative will force anyone applying for a driving licence online to express a view on whether they want to join the register.
Chris Rudge, national clinical director for transplantation, said: “We may be able to help save more lives and keep families together for longer if more people sign up.
“This trial will prompt everyone in Birmingham applying for or renewing their driving licence online to take the positive step and sign up.
"Around 250 people in Birmingham are currently on the waiting list for a transplant.
“Sadly, around 1,000 people in England die each year while waiting for a transplant or because they have become too ill and are removed from the list.”
It was not clear why Birmingham fared so badly over signing up to the transplant register.
Health chiefs previously tried to dispel the belief that some faiths do not allow organ donation, saying virtually all mainstream religions viewed such acts as unselfish and charitable.
More than 8.5 million people have joined the donor register since the Driver and Vehicle Licensing Agency added questions about donorship to its online driving licence applications.
But applicants will now have to tick one of three boxes to answer an organ donor question before they can complete their form, unlike the existing scheme where the questions are not obligatory.
Public health minister Anne Milton said: “Being an organ donor is a truly selfless act and a life-saving gift to someone in need. We want to make it easier for people to sign up to the Organ Donor Register when they apply for their driving licence and encourage everyone in Birmingham to discuss their organ donation wishes with their loved ones.”
Details of the transplant register are available at www.organdonation.nhs.uk or on 0300 123 2323.