It will take more than an opt-out system to increase organ donation: prioritise donors to receive organs

On 1 December 2015, Wales will unilaterally become the first country of the United Kingdom to introduce an opt-out system for organ donation.1 Political leaders in Scotland and Northern Ireland are debating similar legislation, and pressure will mount for England to jump on the opt-out bandwagon. Many supportive organisations are keen for change, including the BMA, which has long advocated the merits of changing to an opt-out system.2 If such arrangements procure more organs for transplantation, many would argue that the moral case for presumed consent is unquestionable.3

Support for an opt-out system is well intentioned but misguided. The balance of evidence was against UK implementation in 2006, although the public supported such a change.4 And recent analyses show that organ procurement is higher in countries with opt-out systems, albeit with a drop in living donation.5 Simple legislative change, however, may not have the same effect on donor rates in other countries, as variation is susceptible to unappreciated confounders.6