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France creates opt out register for organ donation

BMJ 1998; 317 doi: (Published 25 July 1998) Cite this as: BMJ 1998;317:234
  1. Alexander Dorozynski
  1. Paris

    A computerised register listing the names of people who have chosen not to donate organs or tissues after their death is being established in France. Anyone not on the register will be presumed to have consented to organ donation, although the family will still be able to object.

    Set up by the Etablissement Français des Greffes, the government controlled transplant watchdog group, the list will enable hospitals to know immediately whether a clinically dead individual had chosen not to be a donor. Only one other European country, Portugal, keeps such a list, with 36000 people registered as non-donors.

    The registry is part of a campaign to encourage organ donations, which have decreased in recent years. In 1997, 320 patients died before a transplant could be attempted, and 5302 patients were on a waiting list.

    Yet polls have shown that nearly nine out of 10 people in France are in favour of organ donation, and no single factor has been identified to explain the decrease, which started in 1991 after a highly publicised incident of a boy's accidental death and the taking of his eyes without specific parental authorisation. The 1992 scandal about blood donations contaminated with HIV and more recent rumours that organs obtained illegally had been used for the benefit of wealthy foreign patients, may also have contributed to the increased number of refusals.

    In 1995, French general practitioners participated in a campaign to inform patients about organ donation and encourage them to donate organs after their death. The current campaign, and the setting up of the “refusal list,” should hopefully help to increase the number of donors.

    Anyone aged over 13 years who is willing to donate organs after death is urged to inform his or her relatives and to carry a donor's card. The new law states that if a dead person does not have such a card, the principle of “presumed consent” will hold, although this should be confirmed with the relatives.

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