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

BMJ 2015; 351 doi: (Published 20 October 2015) Cite this as: BMJ 2015;351:h5165
  1. Adnan Sharif, consultant nephrologist, Department of Nephrology and Transplantation, Queen Elizabeth Hospital Birmingham, Birmingham B15 2WB
  1. adnan.sharif{at}

Radical innovation, such as prioritising donors to receive organs, is needed to help change attitudes, argues Adnan Sharif

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

Education and training

Any success in Wales will probably owe more to mass publicity than to legislative change alone. Spain, the leading light for …

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