Intended for healthcare professionals


Scotland agrees on new opt-out organ donation system

BMJ 2019; 365 doi: (Published 12 June 2019) Cite this as: BMJ 2019;365:l4180
  1. Bryan Christie
  1. Edinburgh

Scotland has decided to follow Wales and England in introducing an opt-out system of organ and tissue donation in an attempt to increase the number of lifesaving transplant operations.

The Scottish parliament has approved the Human Tissue (Authorisation) (Scotland) Bill, which will result in all people over 16 being deemed to be organ donors unless they opt out. Currently, people have to opt in by registering their willingness to have their organs used after their death.

Scotland has the UK’s highest proportion of people on the organ donor register but the lowest rate of family consent. This has led to it having the lowest rate of donation.

In 2015 Wales was the first part of the UK to introduce an opt-out system, and the evidence of that change is encouraging. Donation consent rates have risen in Wales and are now the highest in the UK at 80.5%, compared with 63.6% in Scotland, 66.7% in Northern Ireland, and 66.2% in England.1

England is due to introduce a similar system next year,2 and Scotland has now decided to follow suit. Currently, 581 people in Scotland are on the waiting list for transplants.

A more positive attitude

No date has been given for the system’s introduction, but it will be preceded by a 12 month awareness campaign, including a direct mailing to every household in Scotland explaining how it will work and how people can opt out. The legislation includes safeguards to ensure that organ or tissue donation will not go ahead where it would be against the person’s wishes.

The landmark legislation was welcomed by the BMA, which has campaigned for 20 years for an opt-out model of organ and tissue donation. Sue Robertson, a kidney specialist at Dumfries Renal Unit and a member of the BMA’s Scottish Council, said that the change would save lives.

“I am hopeful that more people than ever before will receive the organs they so desperately need,” she said. “I also believe that organ donation will become the norm over time, with more people having discussions with their families about their wishes, and a more positive attitude towards donation within society.”

An online poll conducted by YouGov for the British Heart Foundation (BHF) in Scotland found that 70% of people supported the legislation. Its Scotland director, James Cant, said, “This bill is an important step in increasing organ donation rates. However, BHF Scotland acknowledges that this legislation is not the end of the process. To achieve a world class donation system, we will need continued support and investment.”

One issue that was highlighted during the debate in parliament was the need to increase the number of intensive care beds.3


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