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Is an opt-out system likely to increase organ donation?
BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l967 (Published 06 March 2019) Cite this as: BMJ 2019;364:l967Linked Patient Commentary
My three livers: how transplants gave me my life back
Re: Is an opt-out system likely to increase organ donation?
Since England’s presumed consent law is already planned for 2020 this debate is no longer opt in vs. opt out, but about how to make a success of it. Therefore, it may be useful to consider the experience of Norway which recent underwent the first major revision of their organ donation legislation for almost 40 years.
Deceased donor rates in Norway are similar to the UK. The country operates a system of presumed consent and there are no organ registers . Patients can indicate a preference in their medical journal, however, clinicians must ultimately gain consent from the family, as is common practice in opt-out systems.
In 2012 revised legislation was introduced which permitted donation after cardiac death. Whilst one would expect this to increase the total number of donations, this has not happened (1). One reason is that the legislation also increased the emphasis on clinicians gaining the informed consent of relatives, which has had the unintended consequence of increasing family refusal rates. Despite high public approval of organ donation (around 85%), for every three eligible, potential deceased organ donors there is one case of family refusal (2).
Ultimately, whether opt-in or opt-out, organ donation is rooted in voluntary reciprocity. Informed consent is a process which needs constant renewal, therefore any attempt to increase donor rates by stealth or quick fixes is a fool’s errand. For England’s presumed consent law to have the desired effect we all – healthcare workers, politicians, patients and wider civil society - have to brace ourselves for a sustained effort for years to come. By using our words, actions and resources, to help nurture a solidaric culture of organ donation throughout society this would truly honour the life of Keira Ball.
(1) Langercrantz, A. (2015). Report from: Promoting Organ Donation in the Nordic Countries. Available: http://merorgandonation.se/wp-content/uploads/2016/03/Promoting-organ-do... (Accessed: 22nd March 2019)
(2) Bakkan 2018 Organdonasjon og transplantasjon Aktivitetstall 1.januar – 31.desember 2018 https://organdonasjon.no/content/uploads/2019/01/4.-kvartal-2018-2.pdf (Accessed: 22nd March 2019)
Competing interests: No competing interests