In an attempt to improve organ donation rates, some countries are considering moving from ‘opt-in’ systems where citizens must express their willingness to be an organ donor, to ‘opt-out’ systems where consent is presumed unless individuals have expressed their wishes otherwise, by for example, joining an ‘opt-out’ register. In Wales - a part of the United Kingdom - the devolved government recently legislated for an ‘opt-out’ system. For the change to be effective, a public awareness campaign was critical to the policy’s success. Using quantitative and qualitative content analysis, we explored media coverage of the change to better understand the relationship between the state, policy actors, media and the public when such policy changes take place. Our findings illustrate how a state communication campaign can effectively set the media agenda within which we saw a degree of interdependency created with the state using the media to promote policy, and the media relying on the state for credible information. Yet we also found that the media is not uncritical and observed how it uses its autonomy to influence policy-setting. Over the period of study, we found that a change in tone and view towards deemed-consent organ donation has taken place in the media. However, while this may influence or reflect public attitudes, it is yet to be seen whether the media campaign translates into behavioural change that will result in increases in organ donations.