Fewer than one in three people in Burnley have signed up to the organ donation register, giving it one of the lowest rates in the UK.
The figures have been released by NHS Blood and Transplant to mark Organ Donation Week.
They show that around five people in Burnley are currently on the waiting list for a new organ, while 12 residents have received transplants in the past year.
NHSBT says the failure of prospective donors to sign the register or inform their families of their wishes is posing an obstacle to life-saving transplants going ahead.
This "fatal complacency" means that a family may refuse to give their consent even if their loved one was happy for their organs to be used.
Just 31% people in Burnley had signed up as a donor as of May last year, based on the latest population estimates.
This figure includes every age group, from infants to the elderly, all of whom are able to join the register.
Scotland, England and Northern Ireland all currently use an opt-in system, under which people can elect to register as a donor.
But both Scotland and England are planning to follow Wales' example and move to an opt-out system in the coming years.
Almost 40% of people in the UK around 25.5 million people - were on the register as of the first quarter of 2018.
However, the NHSBT figures reveal wide variations between local authority areas, with the proportion of those registered ranging from just 16% in areas such as Harlow and Newham up to a high of 83% in Dorset.
Five of the bottom 20 areas for donor registration are in London, while most are metropolitan or urban areas.
NHSBT said it recognised that there was a disparity between urban and rural areas, with higher levels of registration in the latter, but didn't fully understand why that was the case.
According to NHSBT, a number of demographic factors could influence the proportion of people on the register in any given area, such as race, religion and age.
Black and Asian people are disproportionately likely to die while waiting for an organ because of a lack of donors from the same ethnic background, who are more likely to be a close match.
Research undertaken by the organisation shows people from ethnic minorities are less likely to talk about donation, while some religious people may have concerns surrounding burial practices.
However, a spokesman from the organisation said that "all the major world religions" approve of organ donation, and that they were working with charities and community groups to raise awareness.
People aged over 50 are also less likely to join the register, because they mistakenly assume their organs are no longer healthy enough to donate.
Only 27% of the people who joined the register last year were over 50, but 72% of people whose organs could potentially be used after their deaths are aged 50 or over.
Anthony Clarkson, interim director of organ donation and transplantation at NHSBT, said: “We don’t want people to die because of a fatal complacency - that because you know you want to be an organ donor you presume your loved ones know it too.
“People are living moment to moment, in desperate need of someone saying ‘yes’ to donation.
“We all know that organ donation legislation will change in England and Scotland in future years but the harsh fact is people are dying right now waiting for an organ and it will still be important for people to know your decision.
“Your family’s role is critical now and it will still be critical in the future."