The BMA began lobbying for a 'soft' opt-out system with safeguards for organ donation in 1999. Legislation to bring this into effect has now been passed in all four nations of the UK and in the Crown Dependencies.
We are delighted to have been a leading voice in the debate for this change for more than two decades, a change which we believe will reduce the shortage of organs and save lives.
- Wales - The Human Transplantation (Wales) Act (in effect since December 2015).
- England - Organ Donation (deemed consent) Act (in effect since May 2020)
- Scotland - Human Tissue (Authorisation)(Scotland) Act (in effect since March 2021)
- Northern Ireland - Organ and Tissue Donation (Deemed Consent) Bill (expected to come into effect in Spring 2023)
- Jersey – Human Transplantation and Anatomy (Jersey) Law 2018 (in effect from June 2019)
- Guernsey – Human Tissue and Transplantation (Bailiwick of Guernsey) Legislation Act 2020 (in effect from January 2023)
- Isle of Man – Human Tissue and Organ Donation Act 2021
How does an opt-out system work in the UK
An opt-out system is designed to make it as easy as possible for each individual’s wishes about organ donation to be respected.
Individuals have a number of options:
- they can record a positive wish to donate on the organ donor register
- if they do not wish to donate, they can register a wish to opt-out of donation
- in England, Wales and Northern Ireland, they can nominate someone to make the decision for them; or
- they can do nothing and their consent/authorisation will be deemed (ie, it will be assumed they wish to donate organs after their death). There are some exceptions. Consent/authorisation is not deemed in individuals who:
- are under 18 in Wales, England and Northern Ireland or are under 16 in Scotland;
- lacked the capacity to make a decision about donation for a reasonable period leading up to their death; or
- had not been ordinarily resident for 12 months in the part of the UK in which they die.
In practice this means that when someone over the age of 18 dies (or under 16 in Scotland) and donation is a possibility:
- the organ donor register is checked and if the individual has opted in, donation can proceed, if they have opted out donation cannot proceed. (In Scotland there is specific provision for either of these decisions to be considered ‘withdrawn’ if evidence is provided that this does not represent the individual’s latest wish.)
- If the individual has not registered any views on the organ donor register, family members will be asked if they are aware of any unregistered objection. If it becomes clear from the information provided that the individual would not have consented, then donation will not proceed.
- If the relatives are not aware of any unregistered objection, donation can proceed and the practical arrangements for this are discussed with the family. There is, however, scope not to proceed if it is evident that to do so would cause severe distress to those close to the patient.
It remains very important that individuals are encouraged to discuss their wishes with their families; it is much easier for everyone concerned if this discussion has already taken place.
Seeking continued improvement
The BMA continues to support:
- ongoing, high-profile publicity to ensure people are aware of the opt-out system and to encourage individuals to discuss their wishes with family and friends;
- steps to ensure that sufficient resources are available to translate extra donors into additional transplants, so that more lives can be saved and transformed;
- ongoing monitoring to identify and address any systemic problems that hinder donation; and
- continued recognition of the individuals – donors, families and staff – who make this amazing gift of life possible.