Intended for healthcare professionals


Time to move to presumed consent for organ donation

BMJ 2010; 340 doi: (Published 04 May 2010) Cite this as: BMJ 2010;340:c2188
  1. Sheila M Bird, senior scientist1,
  2. John Harris, director2
  1. 1MRC Biostatistics Unit, Cambridge CB2 0SR
  2. 2Institute for Science, Ethics and Innovation, Manchester M13 9PL
  1. Correspondence to: S M Bird sheila.bird{at}

    Given the UK’s modest 60% consent rate for donation of organs from brain stem dead donors, Sheila Bird and John Harris argue that allowing donation unless the donor has explicitly opted out would substantially increase the number of organs available

    The United Kingdom’s current policy on organ donation encourages people who are willing to donate organs after their death to opt-in while they are alive, rather than leave the decision to their relatives after death. In practice, even when people have expressed their willingness to donate by either carrying a donor card or, since 1994, signing up to the computerised NHS Organ Donor Register, their relatives are always asked for consent and relatives’ refusal overrides the deceased would-be donor’s decision.

    In 2008, Prime Minister Gordon Brown asked an Organ Donor Taskforce to consider the potential effect of an opt-out system for organ donation in the UK.1 This system presumes consent unless in life, the deceased person had opted out of all or organ specific donation. The taskforce commissioned research on the effect of presumed consent on organ donation rates2 and, rather against the results of that research,3 recommended no change to current policy but renewed effort to increase the number of donors opting in.1 For example, a UK-wide network of hospital organ donation “champions” was launched in February.4

    We argue that the taskforce did not consider all the relevant evidence, particularly on relatives’ refusal rates, and that the current policy, however reinforced, will not substantially increase the number of organs available. By modelling different scenarios, we show that only a policy of presumed consent will substantially increase the number of organs available for transplantation.

    UK donation

    In the late 1980s, the UK’s publicity for organ donation urged people to “Carry the Card” to indicate their willingness to …

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