Organ Donation

Definitions

Opt In: You are not on the Organ Donation Register unless you sign up.

Opt Out: Anyone over the age of 18 who has lived in England for over a year and has capacity to consent is considered a donor unless they opt out.

  • Soft Opt Out: The family has the final choice to whether the patient’s organs are donated once the patient dies.

  • Hard Opt Out: The family has no say in whether the organs are donated once the patient dies. If the patient is on the Organ Donation Register, their organs are harvested.

In order for the organs to be harvested, the patient must be declared dead by a doctor. This can be on the grounds of:

Circulatory Death: When the heart beat, circulation and tissue oxygenation irreversibly stops.

Brain Death: Irreversible brain damage causing the end of independent respiration

Organ Donation Laws

  • Wales: Soft Opt Out since December 2015.

  • England: Soft Opt Out since May 2020.

  • Scotland: Soft Opt Out since July 2019.

  • Northern Ireland: Soft Opt Out since June 2023.

Organ Donation Issues

In 2021, a lack of organs resulted in 421 deaths.

In June 2023 in the UK, there were over 7000 people on the UK Transplant waiting list.

There are two types of death, a circulatory death and brain death. However, circulatory deaths often mean that organs can’t be harvested as less blood reaches the tissues causing them do necrose (die) and the organs to be inviable. Therefore, circulatory death rarely leads to a donation, and with increased car safety, brain deaths are becoming less common. Only 1% of deaths result in viable donations.

Opt in vs Opt out

An Opt In System

Advantages

  • Donation rates were already increasing. Before the Opt Out system, there was an 11% increase in deceased donors and a 7% increase in lives improved/saved. Increasing education could increase donors without putting additional pressure on the patient.

  • Patients at the end of life may feel pressure not to opt out, even if its against their wishes.

Disadvantages

  • Many people are unaware/forget to Opt In.

  • With the Opt In system, supply was not meeting the demand (421 deaths in 2021).

Under the Opt In system, organ supply never reached the demand and so in 2020 England became a Soft Opt Out System. Anyone over the age of 18 was considered a donor unless they:

  • Opted Out.

  • Are not living in England voluntarily/lived in England for less than a year.

  • Don’t have capacity to consent.

An Opt Out System

Advantages

  • Spain has the worlds highest organ donation rate and it employs a Soft Opt Out scheme (47 donors per million, compared with 18 donors per million in the UK).

  • Dramatically increases consent rate. When Wales implemented it, there was a dramatic increase in people on the Organ Donation Register (58% → 77%).

  • In a UK survey before the implementation of Opt Out, 80% of people agreed with organ donation although only 38% of people opted in. By implementing it, many more organs will be donated.

  • As science advances, more transplants will be possible and successful. Therefore, demand for organs will increase.

  • As of June 2023, only 5.5% of the population which are registered with a GP have opted out.

Disadvantages

  • It suggests your body belongs to the government.

  • May pressure people into donating their organs or cause people to feel guilty.

  • Familial consent is required in Soft Opt Out. The Guardian suggest about 10% of donations are stopped by the family.

  • Hard Opt Out systems can make death even more traumatic for the family (e.g. in Singapore).

The main issue with the 2020 Opt Out system in England is familial consent. There needs to be more education and encouragement for people to discuss organ donation with their families to prevent this barrier.