What is opt out donation and how can it save lives?

Jane Abbott, Benenden Hospital Director, explores the topic of opt out donation

The current system for organ donation in England requires an individual to actively sign up to the organ donor register. While 80% of people, when asked, say they would happily donate their organs after their death, only 36% have gone through the formal process to ensure this can happen.

From 2020, opt-out organ donation will be in place in England. The government said that it would save 700 lives a year. You may hear the new law referred to as ‘Max and Kiera’s Law’. Wales has already adopted an opt-out policy in 2015. Scotland plans to introduce a similar scheme, and Northern Ireland have expressed interest.

What is opt out?

Opt out organ donation means that, from spring 2020, all adults in England will be considered an organ donor when they pass. There are some exceptions to this. You can still choose to opt out by recording your decision not to donate. Some people are also automatically excluded. This includes:

  • People under 18

  • People who have lived in England for less than 12 months

  • Anyone who is not living in England voluntarily

  • People who lack the capacity to understand the change

Anyone who will be automatically opted in can still choose whether or not they want to be a donor, and their families will still be involved – as in the current system.

Why do we need an opt out system?

Under the current system, there are 6,400 people in the UK on the transplant waiting list. Three people die every day while on it. It is thought that as many as 30 donation opportunities are missed a day.

I believe that the ‘opt-out’ system, where consent is deemed to have been given unless an individual has specifically expressed otherwise, could make a huge difference to the number of organ donations offered in this country. I know some people feel anxious that such a system may mean medical teams might work less hard to save someone’s life, but I know our priority is to save life.

As a nurse, I worked most of my clinical career looking after people with kidney failure which included those who needed, or who had just had a kidney transplant. One guiding factor as to whether or not to use an organ for transplant is the age of the organ and its match to the potential recipient. It makes little sense to transplant an 80 year old’s kidney into a 19 year old. On the other side when caring for very sick patients in the intensive, or high dependency, care setting, the focus is always first and foremost on saving the life in front of us, the potential for organ donation only arises when everything else has failed.

Importantly, it is usual practice in the UK that only when next of kin give permission for organs to be used that the donation can go ahead. The intensive care team do all they can to save a patient. It is only when that becomes impossible and consent is given that the transplant team are brought in and they will retrieve the organs and find matches as quickly as possible.

The way the system stands at the moment, a doctor is required to ask the nearest and dearest – at that traumatic time – whether their next of kin had considered donation. Agreeing to donation can be an exceptionally difficult decision to make if the patient had not previously expressed an opinion or joined the register. If their relative is on the register, 91% of families agree to donation. If not, that figure falls to 47%.

Under opt-out, you still have the agency to decide what happens to your body after you pass. The NHS will not take organs without permission. Your family will continue to be consulted before donation. That means it’s very important to share your choice, whatever it is, with your family and friends. 

In the meantime, if you haven’t already, you can register and have those difficult conversations with your family. In the meantime, if you haven’t already, I urge you to register and also to have those difficult conversations with your family. It is important that you share your decision to be an organ donor with your family, so they have to confidence to honour your decision.

You could save lives.

If you have found yourself affected by bereavement and are struggling with grief, Benenden Health members can call the Mental Health Helpline. The helpline can offer 24 hour support from a qualified therapist during this difficult time.