Organ donation in England will take place on an opt-out basis from next year, now that a new law has been passed by MPs. But its effects on donation rates may be being overstated, finds Clare Wilson
27 February 2019
How is the UK organ donation law being changed?
People’s wishes about organ donation after death are currently gauged on an opt-in basis in most of the UK. That means you can give consent for donation on an online organ donation register. But as in nearly all countries, there are far more people who need a transplant than there are organs available, with several hundred people dying every year in the UK while on the waiting list. In a bid to change that, from next year, in England the system will switch, so that everyone will be assumed to have given consent unless they opt-out. This is already in place in Wales and there is a similar proposal in Scotland.
The new law has been named “Max and Keira’s Law” after Keira Ball, 9, was involved in a car accident in October 2018. Four of her organs were donated to other patients, including Max Johnson, aged 9 at the time, who had heart failure caused by a viral infection.
How do you opt-out of organ donation in the UK?
It is a simple process, by adding your name to a register on a website, which already exists. You will also be able to do it in other ways, such as by post. There is no need to do anything until the law takes effect, which should be in the first half of 2020.
So in future will organ donation always happen if you haven’t opted out?
No. Families will have the final say, which is also the case at the moment. In other words, they can overrule their relative’s wishes, whatever they were. This is known as a “soft opt-out” system.
Why is that being allowed?
What is often unappreciated is that organ donation is medically possible only if people have died under an unusual set of circumstances that are sudden and extremely distressing for the family.
Is there an age limit for organ donation?
There is no age limit for organ donation, but it usually involves a young and previously healthy person who has been in a road accident. The person has to have suffered catastrophic and irreversible brain damage that leaves them brain dead, but their heart is still beating and they are on a ventilator. This means their organs are still being supplied with oxygen and so they are in good enough condition to be used for transplant.
Devastated families are in the midst of incredible distress as they reach agreement with doctors on when to turn off the ventilator. It can be difficult for doctors to even broach the subject of organ donation at this time; telling families they have no choice would be controversial. These are the circumstances for less than 1 per cent of all deaths, and is the real reason for the organ shortage.
Is the shortage going to be solved by an opt-out system?
Sadly not. There are hopes it may raise the number of families who agree to donation, although one study that surveyed people on this question suggested it could even be counterproductive, making relatives more likely to say no. But Wales introduced an opt-out system in 2015 and there are initial signs that the consent rate has increased. Spain has one of the highest organ donation rates in the world. What helped there was introducing specialist staff whose job it is to talk to bereaved families at the critical point. Hospitals are also paid according to their donation rates. That might be a step too far for the UK.
More on these topics: