In Depth

What are the pros and cons of ‘opt out’ organ donation?

All adults in England are automatically organ donors from today


Every adult in England will automatically become an organ donor when they die under a change to the law today that assumes consent unless a person opts out.

The change has been dubbed “Max and Keira’s Law”, after schoolboy Max Johnson, now 12, who is alive thanks to a heart donated from Keira Ball, killed in a car crash at the age of nine.

The law seeks to make it easier for people to donate their organs and save hundreds of lives a year. At present, 80% of adults in England say they would consider becoming an organ donor, but fewer than 40% have signed up to the register, says The Guardian.

Around one in 100 people who die in the UK are able to donate their organs, but a shortage of registered donors means hundreds of people die waiting for transplants each year, says ITV News.

It is hoped the law will lead to an additional 700 transplants each year by 2023, and make discussions about organ donation feel more normal, adds Metro.

Faizan Awan, one of thousands of people across the UK awaiting a transplant, told the paper: “For many people like me, who are waiting for an organ, the law change is a sign of hope and a transplant would dramatically change my life in a number of ways.”

At present, every potential organ donor is being tested for Covid-19 and if someone has it, they will not be able to donate, according to the NHS.

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What is automatic organ opt-out?

Under the scheme, patients aged 18 or over will have to opt out if they do not want to be an organ donor. People who choose to opt out will need to register to do so, just as patients are currently required to register to opt in.

Families of those donating their organs will still be able to withdraw consent on behalf of their loved ones.

Before the change, organs and tissues could, organ and tissues can only be taken from patients in England if the deceased joined the Organ Donor Register (ODR) or informed their relatives before their death that they wished to donate.

More than 6,000 people are on the organ waiting list in England, and an average of three people in need of an organ transplant die each day. In 2018, more than 400 people died in the UK waiting for a transplant, the BBC reports.

The overall donor consent rate in the UK has risen from around 60% in 2015 to 67.5% in 2018, with Wales reporting consent rates as high as 75%.

What is family refusal?

Family refusal is currently the “biggest obstacle to donation”, says the NHS. Around 91% of families agree to organ donation if their relative is on the organ donation register (ODR), according to figures from the NHS Blood and Transplant potential donor audit.

However, when patients are not on the ODR then 47% of families say no to a donation.

Under the existing system, grieving families are given the choice if a patient’s wish to donate is not known, “but less than half give consent for the organs to be donated”, says Metro.

Black, Asian and minority ethnic (BAME) communities are particularly needed on the register. A quarter of the people on the current waiting list are from these communities, but people from those backgrounds are less likely to have chosen to donate, or have had organ donation blocked by relatives.

Theo Clarke, former national BME marketing manager at NHS Blood and Transplant, said: “South-Asian patients wait longer than white patients for transplants as there are not enough suitable organs available.”

In a bid to address this discrepancy, the new opt-out scheme will also include a new system to record an individual’s faith and ensure the NHS consults religious leaders or family members on any traditions that need to be respected.

The pros and cons of automatic organ donation

Arguments for automatic organ donation:

  • More than 6,500 people in the UK need a transplant, but a shortage of donors means that around 3,500 transplants are carried out annually
  • Advances in medical science mean that the number of people whose lives could be saved by a transplant is rising more rapidly than the number of willing donors.
  • The law as it was previously condemned many, some of them children, to an unnecessary death, simply because of the shortage of willing donors while, as the British Medical Association puts it, “bodies are buried or cremated complete with organs that could have been used to save lives”.
  • Doctors and surgeons can be trusted not to abuse the licence which a change of the law would grant them.
  • Objections to a change in the law are sheer sentimentality. A dead body is an inanimate object, incapable of feeling.

Arguments against automatic organ donation:

  • Few question the value of transplant operations or the need for more donors. But a programme designed to recruit more donors is preferable to a change in the law.
  • The law change implies that our bodies belong to the state as soon as we are dead. The assumption is offensive.
  • Organ removal without the expressed wish of the deceased could be distressing for his or her family.
  • The change in the law is open to abuse, with the possibility of death being hastened to secure an organ needed by some other patient.
  • The safeguard - that is, the right to refuse permission for your organs to be removed - is inadequate. A terminally ill patient or his/her relatives would be made to feel selfish if permission was withheld.
  • Families may feel the wishes of their loved ones are more ambiguous compared to opt-in systems, leading to higher risk of family refusal.


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