Expert advice

What you need to know about the opt-out organ donation system

The implications as England joins Wales in adopting presumed consent for organ transplant
A woman looking at a web page in relation to organ donation, which reads 'register to not donate'

The implications as England joins Wales in adopting presumed consent for organ transplant after death

On 20 May, the Organ Donation (Deemed Consent) Act 2019 comes into force.

This means that England joins Wales in having an opt-out system of organ donation rather than an opt-in system.

When an individuals organs may be used after death

The difference between the two is that an opt-in organ donation system requires a person to actively state that they wish their organs to be used after death. The presumption is that unless they opt in,

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The implications as England joins Wales in adopting presumed consent for organ transplant after death

A woman looking at a web page in relation to organ donation, which reads 'register to not donate'
Individuals can ‘opt out’ by recording their decision on a national register Picture: iStock

On 20 May, the Organ Donation (Deemed Consent) Act 2019 comes into force. 

This means that England joins Wales in having an opt-out system of organ donation rather than an opt-in system.

When an individual’s organs may be used after death

The difference between the two is that an opt-in organ donation system requires a person to actively state that they wish their organs to be used after death. The presumption is that unless they opt in, they do not want their organs to be used. If they do nothing, it is unlikely their organs will be used.

With an opt-out organ donation system, a person is deemed – or presumed – to consent to having their organs used for transplant after death, unless they opt out of this by recording their objection on a national register.

Under this opt-out system, unless a person actively states they do not want their organs to be used after death, their organs will be available for transplant. 

The opt-out organ donation system in England and Wales is a so-called ‘soft’ opt-out because it is not a strict ‘all or nothing’ approach.

    Exceptions under the new opt-out system in England

    Under a strict opt-out system, if a person does nothing their organs can be used, whereas a soft opt-out has a safeguard built into the system – if a person has not opted out, their relatives will be consulted, and if it is considered that the individual would not have wanted their organs used, this will be respected.

    Certain individuals are not eligible for the opt-out system. These are referred to as excluded groups and include people who: 

    • Are under age 18.
    • Lack the capacity to make a decision before their death.
    • Have not lived in England for at least 12 months before their death.

    As the opt-out system does not apply to children under age 18, where a donation decision is required for someone under 18, the family will be asked to make that decision and provide consent.

    How organ donation systems vary across the UK

    Although 20 May marks the day of change in England, Wales has had an opt-out organ donation system for almost five years; in December 2015, Wales became the first country in the UK to move to this system.

    Scotland is expected to move to an opt-out system in September, but Northern Ireland will continue to use the opt-in system.

    In England, Wales and soon Scotland, everyone will now be a potential organ donor unless they opt out or are in one of the excluded groups.


    Marc Cornock, a qualified nurse, academic lawyer and senior lecturer at the Open UniversityMarc Cornock is a qualified nurse, academic lawyer and senior lecturer at the Open University

     

     

     


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