Presumed Consent

We are often asked why we are not actively pushing for an opt-out system for organ donation.  This is a brief explanation of opt-out and where we stand on the issue.

What is opt-out?

An opt-out, or presumed consent system, presumes that everyone wants to donate their organs unless they have stated otherwise.  As it stands at the moment, it is presumed that you do not wish to donate your organs unless you state otherwise (ie sign up to the Organ Donor Register).  If you have not signed the Organ Donor Register your next of kin would need to be consulted as to what your wishes may have been, should you ever be in a position to be an organ donor.  Various transplant-related groups are pushing quite strongly for the UK to change its system to one of presumed consent.

What is LLGL's stance on presumed consent?

LLGL are not currently campaigning to change the UK system to one of presumed consent.  This is for a variety of reasons.

At first glance, there is reason to assume that changing to an opt-out system would solve the organ shortage in the UK - though on closer inspection it is much more complex than this.  The current transplantation system in the UK has been undergoing a huge overhaul, triggered by the release of the Organ Donor Taskforce report in January 2008.  The report identified 14 key points within the system which needed attention and reform, one of which was infrastructure; we did not have the capacity to deal adequately with increased levels of organ donation.  It is vital that this key point is one of the first to be rectified, and steps are already underway to improve things.  

One of the leading countries in the world with regard to organ donation rates (relative to population) is Spain.  Spain does have an opt-out system, however Dr Rafael Matesanz, President of the Spanish National Transplant Organisation, states that the legislative shift to presumed consent is not what improved their donor rates:

"During the early 1990s we had a 30% refusal rate; at the moment it's about 15%," Dr Matesanz says.  "Many countries try to increase organ donation through legislation.  But a change to presumed consent doesn't improve the donation rate".

One major concern for us are the myths and misconceptions which surround organ donation.  Until people are better educated we do not believe that radical changes to the law would be effective as people would still be making decisions based on erroneous information.

If the UK changed to an opt-out system, it would be called a "soft" system where, despite the premise being that it is assumed the person wanted to donate their organs, the family would be asked whether they would like donation to go ahead.  The family refusal rate in this country is currently 40%, and it could be the case that this would rise since the loved one would not have made an active move to join the Organ Donor Register, leaving the family less certain of their wishes.

In 2008, the Organ Donor Task Force did an independent report on the potential impact of an opt out system and came to the conclusion that it would not benefit the UK at this time. Their report revealed that such a system would require £45 million to implement.  We believe that more vital elements which are now being invested in, such as the employment of more specialist nurses, are far more important.  If the focus is taken away from the implementation of key recommendations like this, they may start to slide.  The UK is in the process of making slow and steady improvements to organ donation.  We are determined to fight to keep those variables that we know for certain make a difference at the forefront of people's attention.

For all the above reasons, we feel it is important to focus on improving the current system through attention to infrastructure, education, funding and staffing, before considering any radical changes in UK legislation.