healthHealth and Medicine

England Could Soon Have An "Opt-Out" Organ Donation Law


Robin Andrews

Science & Policy Writer

Opt-out won't be a silver bullet. Gorodenkoff/Shutterstock

At present, you have to sign up to a registry to become an organ donor in the UK. However, as reported by BBC News, there are plans to introduce an opt-out system of organ donation in England from 2020, pending parliamentary approval in the coming months.

Under such a system, everyone is presumed to be an organ donor unless they make it explicitly clear that they don’t wish to be included in the system.


Thanks to the nature of the devolved political system in place in the UK, its constituent parts have different laws regarding organ donation at present. The opt-out system has been in place in Wales since 2015. Scotland plans to bring in a similar scheme, and Northern Ireland is also beginning to head in that direction too.

Clearly, we don’t yet live in a time where new organs can be effortlessly grown in a laboratory. Some incredible advances have been made, of course, and it seems increasingly likely that growing human tissue from our very own stem cells – to ensure compatibility with the patient – will be a feature of the future.

At the moment, though, we rely on organ donors to save our lives should our own bodies begin to irrevocably fail – and that’s sometimes a huge problem. In the UK in 2017, 411 people died after exhaustive searches for compatible donors succeed but just a little too late.

A 2017 study by the British Medical Journal found that deceased organ donor transplantation is “increasingly successful” in the UK. There are more donors and recipients than ever before, and long-term survival rates are on the up. It also stressed, however, that this “masks a continuing shortage of donated organs.”


At a glance, it is clear that an opt-out system would save more lives than an opt-in system, but as ever, things are more complicated than they first appear.

One survey in particular, a 2015 assessment of American public attitudes, stands out. In the US, the “dead-donor rule” (DDR) applies, which states that vital organs should only be taken from people that are dead. This has stimulated plenty of discussion as to whether or not living patients, such as those near-death but on life support, should also be allowed to donate organs.

This survey found that even when it was clear that organ removal would explicitly trigger the death of heavily infirmed patients, the majority agree that it should be legal for them to donate organs, in violation of the DDR.

The opt-out rule isn’t a silver bullet, though, and there’s some debate over how effective it would be.


A 2008 UK government-commissioned report on an opt-out system concluded that it shouldn’t be introduced. Although this was related to an erosion of trust in officials and the undermining of the concept that a donation is a gift, they also found no evidence that it would deliver significant organ donor increases.

Leading medical professionals in the UK have recently hailed the potential to alter the law, but the UK’s National Health Service said plans are threatened by a shortage of transplantation staff and equipment. At the same time, there will still be those who will oppose such a change.

That BMJ report, for example, found that 38 percent of families refuse consent, even if the patient is on the organ donor register, and has therefore given their legal consent. Few surgeons would obtain said organs if the families protested.

It’s complex. Seeing as the latest bill has wide cross-party support, it'll likely pass, so it’ll be interesting to see how donor numbers change as the law itself does.


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