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The Big Question: Should organ donation be "opt-out"?

Should organ donation be "opt-out"?

Should organ donation be "opt-out"?

David Wilson

Pathology and Immunology Manager

Aberdeen Royal Infirmary

This question is more a social and political question than scientific. We have to be clear that the only reason to undertake this change to an opt-out system is to improve the deceased organ donation rates. The usual case quoted is that of the Spanish opt-out system, which had a decease organ donation rate of 35.3 per million population (pmp) in 2013, compared to that of the UK opt-in system of 21.0 pmp. However, if we look at other countries in Western Europe we find cases where opt-out is less successful, Sweden with 15.1 pmp and Italy with 21.7 pmp. Even within the UK, Wales recently moved to an opt-out scheme in December 2015, where they saw a marginal fall from 20.8 pmp in 2014-15 to 20.3 pmp in 2016-17.

What is missing from this discussion is why we see this variation in opt-out schemes. This could be due to factors such as the availability of a transplant coordinator, ventilators, operating theatres and the influence of social and cultural views. 

The lack of clear supporting evidence makes it difficult for me to support a change to opt-out. If I was ensured that we were getting the support correct to assist donation, then I would be more likely to support opt-out. Until we 
address this issue, then moving to an opt-out system may not deliver the improvement we are seeking. In the meantime we should monitor and support the initiative in Wales to maximising the potential of deceased organ donation.


Gordon Sinclair

Senior Biomedical Scientist

The Royal Marsden NHS Foundation Trust

For about 140 years Britain’s prevailing belief system has been materialism, and thus the use of “free” organs for the benefit of others makes complete sense.

Anything that could help to increase the supply of organs seems to be a 
logical choice.

There are, however, those who believe that our bodies have been made holy and are home to God Himself.

We believe that Christians not only represent Christ in the world but that 
we are part of Him and even after death remain holy.

The apostle Paul asks the following question: “Should I take the members of Christ and join them to a harlot?” And answers with an emphatic “no”. The joining of part of my body (God’s house) before or after death, to another who is not a Christian, would defile it and thus is morally wrong.

There is a problem if a person fails to make their choice known in either the opt-in or the opt-out systems. With the opt-in system, we run the risk of missing some of those who are prepared to have their organs harvested.
With the opt-out system, we run the risk of harvesting organs from those who do not want this to be done.

I do not believe, however, that these two errors are morally equivalent and thus I believe we should not have an opt-out system.


Nick Kirk

Pathology Manager

Royal Papworth Hospital NHS Foundation Trust

Currently within the UK there are over 7,000 people on the transplant waiting list and last year 1,300 people died while waiting for an organ. At Royal Papworth Hospital we have transplanted 100 hearts in 2017-18 and new technologies are coming on stream to recondition hearts that normally couldn’t be used, but there still aren’t enough. Informed opting out would be a major step forward in addressing this shortfall and would save many more precious lives.

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