There has been a period of intense activity in the UK to improve the organ donation infrastructure. This has led to the UK deceased donor rates increasing by 67% and deceased donor transplant rates increasing by 49% in the last 10 years. However, there is a limit to what can be achieved solely by health care system changes. Many countries within the UK are therefore in the process of changing the legal basis of consent, from ‘opt in’ to ‘opt out’.

The change in legislation is supported by the precedent set in Wales, which introduced opt out in December 2015. Since changing their law, Wales’ consent rates have increased significantly and are now the highest in the UK.

UK Deceased Donor Consent Rates
Country        2015         2018/19         %Increase
England         61%         67%             +6%
Scotland        54%         64%             +10%
N. Ireland      59%         63%             +4%
Wales            58%         77%             +19%
Source: NHS Blood and Transplant

The introduction of opt out is anticipated to increase support for organ donation and improve consent rates, but is not without risk. One of the largest challenges is the perception of deemed consent. The Government’s public consultation responses showed the concern that organ donation would no longer be a gift freely given, but a State-enforced requirement. This was particularly prevalent in BAME communities. Work is being taken forward with faith/ belief groups, community leaders and others, to dispel this perception. This is supported by a major marketing campaign, to raise public awareness that the law is changing, but the organ donation decision rests with the individual.

Another significant challenge is ensuring that the NHS is ready for the new legislation. This requires co-ordinated action by Government, NHS Blood and Transplant, Commissioners, IT providers, Regulators, Professional Representative Organisations and many others. Comprehensive training is being provided to organ donation teams, to ensure that they understand the change in law and are able to confidently and sensitively incorporate the requirements into the family discussion.

Although the new system is not yet in place, benefits are already being realised in England and Scotland. The increased collaboration across different stakeholders as the legislation progressed through Parliament led to new, positive relationships, which are delivering improvements in the profile and support for organ donation and transplantation. The additional Government commitments are also delivering changes. These include the introduction of a new faith/ belief declaration on the Organ Donor Register and improved information on our websites about how organ donation can be taken forward in line with faith and beliefs.

The introduction of opt out legislation is not the sole answer to the organ donation crisis or gaining public support. However, it is a vital lever which, alongside continued work to improve the infrastructure, we anticipate will increase consent rates and save hundreds of additional lives each year through the gift of organ donation.