Organ donation

The BMA has long advocated a 'soft' opt-out system for organ donation across the UK.

Location: UK
Audience: All doctors
Updated: Tuesday 8 September 2020
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The BMA has long advocated a 'soft' opt-out system with safeguards for organ donation. We believe this is the best option for the UK to reduce the shortage of organs and save lives.

 

Organ Donation (deemed consent) Act 2019 in England

The BMA supported the Organ Donation (deemed consent) Act throughout its stages of scrutiny in Parliament. As well as our parliamentary briefings, our members wrote to their local MPs about the importance to doctors of bringing about this life-saving change in law.

Opt-out system in other UK nations

An opt-out system was introduced in Wales in 2015 and similar legislation has now been passed in England and Scotland. It is expected that the new system will be in place in England and Scotland in 2020. We will continue to call for an opt-out system in Northern Ireland.

 

How does an opt-out system work in England?

Before change is implemented, there will be an extensive, high profile awareness campaign to inform the public about the changes and to encourage them to consider their own wishes about donation after their death.

Adults have a number of  options:

  • if they do not wish to donate, they can register a wish to opt-out of donation
  • they can record a positive wish to donate on the organ donor register
  • they can nominate someone to make the decision for them
  • they can do nothing and their consent will be deemed (ie, it will be assumed they consent to act as a donor after their death). 

Once implemented, when someone over the age of 18 dies and donation is a possibility, the opt-out register is checked and if the individual has opted out donation cannot proceed.

As an extra safeguard, if the individual has not opted out, family members will be asked if they were aware of any unregistered objection. If it becomes clear that the individual would not have consented, then donation will not proceed.

Importantly, any person who had a known objection to organ donation, through formally opting out or otherwise, would not be a donor.

If the relatives are not aware of any unregistered objection, donation can proceed and the practical arrangements for this will be discussed with the family.

There is scope not to proceed if it is evident that to do so would cause severe distress to those close to the patient.

It is important that individuals are encouraged to discuss their wishes with their families, as it is much easier for everyone concerned if this discussion has already taken place.

 

Organ donation in Wales

The Human Transplantation Wales Bill was passed by the National Assembly for Wales on 2 July 2013 and given royal assent on 10 September 2013.

The aim of the Bill is to increase the number of organs and tissues available for transplant.

BMA Cymru Wales welcomes this measure, as we believe a 'soft' opt-out system is the best way to increase the number of organs available for transplant and save more lives.

How does the opt-out system work in Wales?

Under the new system in Wales, which started on 1 December 2015, there are two forms of consent in law - deemed consent, by those people who have not registered to opt-out of donating an organ, and express consent, by those who have registered to say they wish to be a donor.

A single register records whether or not someone wants to be an organ donor. Donors can also record any wish to donate certain organs but not others.

Relatives can object if they know that the deceased would not have consented. Medical staff would then use their judgement, based on the information provided, to decide whether or not to proceed with using the organs. The information must be sufficient to lead a reasonable person to conclude that they knew the deceased would not have consented.

Deemed consent does not apply to anyone under the age of 18, someone from Wales who dies in another part of the United Kingdom and individuals who are not thought to have the mental capacity to make a decision on whether or not to be an organ donor. Individuals need to have been 'ordinarily resident' in Wales for at least 12 months before their death.

BMA campaign in Wales

BMA Cymru Wales has been actively involved in the campaign since 2006, when we called for a change to the system. This started the debate in the media and in the Assembly.

  • July 2006 BMA Cymru Wales calls for the first law to be made in Wales to change the organ donation system to opt-out.
  • October 2007 Wales Health Minister Edwina Hart reveals she is personally in favour of presumed consent.
  • November 2007 A Wales-wide debate about organ donation is launched.
  • January 2008 Prime Minister Gordon Brown says he is in favour of presumed consent.
  • July 2008 The National Assembly's health committee rejects the idea of opt-out, instead it calls for investment to increase transplant capacity.
  • November 2008 The UK Organ Donor Taskforce also rejects the idea of presumed consent, setting out a series of recommendations to increase donation under the current system.
  • December 2009 Wales Health Minister Edwina Hart announces Wales will pursue legislation to introduce opt-out.
  • June 2011 First Minister Carwyn Jones includes an opt-out Bill in the Welsh Government's legislative programme.
  • November 2011 The Welsh Government publishes its White Paper proposing a move to opt-out in Wales.
  • June 2012 The Welsh Government publishes the draft Bill.
  • July 2013 The Human Transplantation (Wales) Bill is passed.
  • September 2013 The Bill receives royal assent.
  • December 2015 The opt-out law came into effect.

Organ donation in Northern Ireland

The BMA has continued to lobby for the introduction of an opt-out system for organ donation in Northern Ireland in line with legislation across all other parts of the UK.

Northern Ireland currently operates an opt-in organ donation system, where a person has to register their consent to donate their organs in the event of their death.

Under an opt-out system there would be a presumption in favour of consent for organ donation unless a person had registered an objection in advance.

If an objection had not been registered, family members would still be given the opportunity to confirm whether the individual had any unregistered objection, as an extra safeguard, before any procedures went ahead.

Why change matters

Currently 46% of Northern Ireland’s population are registrants on the NHS Organ Donation Register.

At present, around 140 people in Northern Ireland are on the transplant waiting list and last year nine people died waiting for an organ.

BMA campaign in Northern Ireland

A private members bill on soft opt-out organ donation was introduced in the 2011 – 2016 mandate of the Northern Ireland Assembly, but was not successful.

Lobbying on this issue has been challenging due to the three-year period when the Assembly was not operational. In November 2019 in the absence of a health minister, BMA’s Northern Ireland council chair, Dr Tom Black, wrote to the permanent secretary for health on the issue. 

BMA has continued to lobby the new health minister, Robin Swann MLA, on organ donation since his appointment in January 2020.

In July 2020 BMA welcomed the health minister’s announcement of plans to hold a consultation on introducing a soft opt-out system for organ donation in Northern Ireland. This consultation is expected to be held in Autumn 2020.

 

Organ donation in Scotland

The stage 1 debate on the Human Tissue (Authorisation) (Scotland) Bill took place in the Scottish Parliament on 26 February 2019.

BMA Scotland has long supported a move to a 'soft' opt-out system of organ donation as a way to increase donations and save lives.

Under an opt-out system there would be a presumption in favour of consent for organ donation unless a person had registered an objection in advance.

If an objection had not been registered, family members would still be given the opportunity to confirm whether the individual had any unregistered objection, as an extra safeguard, before any procedures went ahead.

Why change matters

In October 2017, around 580 people in Scotland with life-threatening illnesses were on the transplant waiting list.
Only 45% of Scotland's population is registered on the NHS Organ Donor Register.

Statistically, more than one in 10 people on the waiting list will die before they get the transplant they need.

Surveys suggest that around 60% or more of the public support a shift to a 'soft' opt-out system.