Last week marked a significant milestone in our nation’s history. Ten years ago, on 1 December 2015, Wales became the first country in the UK to introduce a 'soft opt-out' system for organ donation. It was a pioneering piece of legislation, one that BMA Wales campaigned for tirelessly. We led the way, and the rest of the UK followed.
A decade on, we should be proud. Since the law changed, over 2,000 organs have been donated in Wales. Specifically, 640 of those organs came from donors whose consent was 'deemed' by the legislation—people who had not registered a decision but had not opted out. That is hundreds of lives saved that might otherwise have been lost.
But we must be honest with ourselves: legislation is not a silver bullet.
The silent waiting room
As I write this, there are roughly 300 people in Wales actively waiting for a transplant and more than 200 people have died on waiting lists in the last decade while waiting for a suitable organ transplant.
For these patients, the 'waiting list' is not an administrative queue; it is a suspension of life. It is a phone that must never be switched off, a bag packed by the door, and the terrifying knowledge that time is not on their side.
The family factor
The assumption many people make is that because we have an opt-out law, the problem is solved. The law presumes consent, so surely donation happens automatically? This is the misconception. Wales operates a soft opt-out system, meaning that families are always consulted. In the traumatic moments following a loved one's death, clinicians will sit down with the family. If the family objects, the donation does not go ahead.
The statistics on this are stark.
When a family knows their loved one wanted to donate (because they registered or spoke about it), 9 out of 10 families support the donation.
When there is no record and consent is merely 'deemed' by the law, that support drops significantly – often to around 50% or 60%.
That gap – between 90% and 60% – is where lives are being lost.
Families often override the deemed consent not because they are opposed to donation, but because they are paralyzed by uncertainty. In the midst of grief, the burden of "guessing" what their loved
one would have wanted is simply too heavy. Without a clear memory of a conversation, they tend to err on the side of caution and say no.
A call to conversation
The law provides the legal framework, but it cannot provide the emotional certainty that a grieving family needs. We need to make organ donation as culturally acceptable and discussable as blood donation. It should not be a conversation we fear.
So, as we mark this 10-year anniversary, my request to you is not just to rely on the legislation.
1. Check the register: 45% of the Welsh population have actively opted in. If you haven't, please consider doing so, on https://www.organdonation.nhs.uk/register-your-decision/
2. Have the conversation: This is the most vital step. Turn to your partner, your parents, or your children today and say: 'If anything happens to me, I want to be an organ donor.'
That single sentence is more powerful than any Act of Parliament. It lifts the burden from your family’s shoulders and ensures that your last act on this earth can be the gift of life.
Sources
– The Anniversary: The Human Transplantation (Wales) Act 2013 fully came into force on 1 December 2015. December 2025 is the 10th Anniversary of implementation.
– Waiting List (Wales): As of late 2024/25, the active transplant waiting list in Wales hovers between 293 and 327 patients. (Source: NHS Blood and Transplant (NHSBT) Activity Reports 2024/25).
– UK Context: There are over 8,200 people waiting across the UK.
– Deemed Consent Impact: Since 2015, deemed consent has accounted for 198 donors resulting in 640 specific organs being transplanted (Source: Welsh Government 10th Anniversary Press Release, Dec 2025).
– Consent Rates: The "Family Consent Rate" disparity (90% when wishes known vs. ~60% when deemed) is a consistent finding in NHSBT reports (Source: NHSBT Organ Donation and Transplantation Activity Report).
https://www.bbc.co.uk/news/articles/cwy9729j8yro
Iona Collins is chair of BMA Welsh council