Organ donation: opt-out system should be in place by 2020 in EnglandBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3414 (Published 06 August 2018) Cite this as: BMJ 2018;362:k3414
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The decision to introduce an “opt-out” system in England is largely positive and reflective of public opinion on organ donation, however one must consider whether this change will really have the intended effect on the rates of organ donation.
The adoption of an “opt-out" relies on the assumption that this will increase the rates of organ donation in England. The opt-out system being considered is one of a “soft opt-out" whereby after an individual has expired, their family will be consulted and the ultimate decision to donate the individual’s organs will rest on their wishes. Whilst the deceased's wishes may still be acknowledged in the decision-making process, one cannot deny feeling that this effectively undermines the whole purpose of the opt-out system. In this way there is little distinction between the proposed plans and the “opt-in” system already in place and one cannot help but feel skeptical that the number of organ donations will improve significantly.
One may proceed to argue that Spain (where legislation for presumed consent was introduced in 1979) has some of the highest rates of organ donation in the world and is a successful example of presumed consent legislation, and therefore we can expect to see an increase in organ donation in the UK by following their example. However, as Fabre et al  argued, the high rates of organ donation in Spain do not reflect the legislation put in place, and other factors exist which contribute to their success: that Spain has more potential donors due to the greater provision of intensive care, that there are long-standing systems established to promote trust in the donation system, and that they have transplant coordinators at most hospitals to facilitate early identification of potential donors .
Furthermore, when considering the introduction of an “opt-out” system in Wales in 2015, there has since been no significant change in the number of organ donations . Whilst this analysis only covered a short period of time and solid conclusions cannot yet be drawn, this does not paint a hopeful picture for the introduction of a similar system in England.
The introduction of an “opt-out” system will inevitably be accompanied by significant costs to train healthcare professionals in communication and education about this new system, whilst continuing to fund existing strategies. It would therefore be wise to analyze and learn from other countries’ outcomes following the adoption of an “opt-out” system, and to subsequently establish an effective national framework, not only to see an increase in the number of organ donations, but to ensure that time, effort and money does not go to waste.
 Frabre, John; Murphy, Paul; Matesanz, Rafael. Presumed consent: a distraction in the quest for increasing rates of organ donation. BMJ 2010;341:c4973.
 Hawks, Nigel. Welsh opt-out law fails to increase organ donations. BMJ 2017;359:j5659.
Competing interests: No competing interests