Keith Mack
In the UK, organ donation is a devolved matter. All regions of the UK now have an 'opt-out' system for organ donation consent, meaning that individuals are presumed to be content to be organ donors upon death unless they signal otherwise. In England, the opt-out system was introduced by the Organ Donation (Deemed Consent) Act 2019 and came into force on 20 May 2020. The law, commonly referred to as 'Max and Keira's Law', states that 'all adults in England will be considered as having agreed to donate their own organs when they die, unless they record a decision not to donate or are in one of the excluded groups'.
| Characteristics | Values |
|---|---|
| Country | United Kingdom |
| Region | England |
| Law | Max and Keira's Law |
| Date Passed | 20 May 2020 |
| Type of System | Opt-out |
| Exceptions | People under 18, people who have lived in England for less than 12 months, people who are not living in England voluntarily, and people who lack the capacity to understand the change |
| Transplant Statistics | 1,429 deceased donors and 958 living donors in 2022/23 |
| Waiting List Statistics | 4,401 people as of 11 September 2020; 6,000 people as of March 2019 |
| Previous System | Opt-in |
| Previous System Statistics | 80% support for organ donation but only 38% opted in |
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What You'll Learn
Opt-out system in England
On 20 May 2020, in the midst of the COVID-19 pandemic, England introduced a "soft" opt-out system for organ donation, also known as 'Max and Kiera's law'. This law states that "all adults in England will be considered as having agreed to donate their own organs when they die, unless they record a decision not to donate or are in one of the excluded groups." The excluded groups include those who are under the age of 18, have been ordinarily resident in England for less than 12 months before their death, or have lacked mental capacity for a significant period before their death.
The opt-out system was introduced to help battle the long waiting lists of patients in need of a transplant. As of September 2020, there were 4,401 people in the UK waiting for an organ transplant, and three people die each day while waiting for an organ. While 80% of people say they would be happy to donate their organs after death, only 37% are registered as donors.
The new opt-out law has put increased demand on transplant services in the UK, and there is a need for increased funding to support this demand. The true impact of the new law has yet to be felt due to the combination of being a new law and the COVID-19 pandemic causing reduced rates of transplantation. Several years on, the anticipated improvements in organ donation rates have not materialised, and the implementation of the law has been more complicated than expected.
To address these challenges, there is a need for increased funding for transplant services, as well as enhanced public understanding of the opt-out system and the role of the family in organ donation. New media campaigns can help explain the process of organ donation and the importance of registering one's decision. Additionally, healthcare professionals should be empowered to implement meaningful changes and ensure that all relevant staff are adequately prepared and equipped to facilitate organ donation.
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Shortage of organ donors
Organ donation is a life-changing procedure for patients, but there is a critical shortage of organ donors worldwide. In the UK, Wales introduced an opt-out system in 2015, which has helped increase the number of organ donors. In 2020, England followed suit and passed a similar law, hoping to address the long waiting lists for organ transplants.
As of 2020, there were 4,401 people in the UK waiting for an organ transplant, with three people dying each day before a match could be found. While 80% of people in England say they would be willing to donate their organs, only 37% are registered as donors. This discrepancy between public sentiment and action has led to a shortage of available organs.
Several strategies have been implemented to address this issue. One approach is to increase public awareness and improve the efficiency of the donation process. This includes encouraging more people to register as donors and ensuring that hospitals are aware of the guidelines to maximize the number of organs available for transplantation. Another strategy is to expand the donor pool by including live donors, split organ donations, paired donor exchanges, and greater utilization of expanded criteria donors, such as donors after circulatory or cardiac death.
Additionally, there is a focus on increasing the number of allografts available for transplant, as they have proven to be highly effective in treating end-stage organ failure. The development of standardized donor management protocols and increased funding for transplant services are also crucial to successfully addressing the organ donor shortage.
The COVID-19 pandemic has further exacerbated the challenges, with transplant rates in the UK falling by over 80%. However, some countries, like Singapore, have successfully carried out transplantations during the pandemic by using a tiered approach and risk-stratifying suitable candidates and donors.
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Exclusions to opt-out laws
In May 2020, the UK passed the 'opt-out' organ donation law, also known as "Max and Kiera's Law". This law states that all adults in England will be considered to have consented to organ donation upon death unless they have explicitly recorded a decision against donation or belong to one of the excluded groups.
The excluded groups include:
- Individuals under the age of 18.
- Those who have lived in England for less than 12 months or are not ordinarily resident in England.
- People who lack the mental capacity to understand the implications of organ donation.
Additionally, the opt-out law does not apply to novel or rare transplants, which require explicit consent. Examples of transplants that are not considered routine include:
- Advanced Therapy Medicinal Products (ATMP): This involves the use of manipulated tissues, cells, and genes to treat diseases or injuries.
- Hand and face transplants.
It is important to note that the family of the deceased will always be consulted, and their loved one's wishes will be respected, even if they have not formally opted out.
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Public awareness campaigns
The UK government launched a public awareness campaign to educate the public about the new organ donation system before it came into force in spring 2020. The campaign aimed to ensure that people understood the new system and the choices available to them. The government also wanted to give people time to have necessary conversations with their loved ones and make decisions about organ donation.
The campaign was part of a 12-month communication strategy that began in April 2019. It was designed to inform the public about the upcoming changes and allow them to make informed decisions before the new system started. This strategy was implemented because there was a shortage of organ donors in England. While 80% of people said they were happy to donate their organs after death, only 37-38% were registered as donors.
The public awareness campaign was also intended to raise awareness among junior doctors, especially regarding the new COVID-19 transplant guidelines. Successful transplantations require extensive training for healthcare professionals, fast retrieval services, pre- and post-operative care for patients, intensive care management, and lifelong follow-up.
The UK government recognised that the new opt-out law would increase the demand for transplant services. To address this, they committed to supporting the NHS in funding, training, and managing transplant centres to successfully implement the new law.
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Impact on transplant services
The opt-out organ donation law in England, also known as 'Max and Keira's Law', came into force on 20 May 2020. The law states that all adults in England are considered to have agreed to donate their organs upon death unless they opt out or are in an excluded group. The excluded groups include those under 18, those who have lived in England for less than 12 months, and those lacking the mental capacity to understand the changes.
The introduction of this law is expected to increase the demand for transplant services in the UK. To successfully implement the law and meet the increased demand, there is a need for increased funding, training, and management of transplant centres. The NHS will need to address logistical challenges and ensure efficient retrieval services, pre- and postoperative care, and life-long patient management.
The opt-out law aims to address the long waiting lists for organ transplants in the UK. As of September 2020, there were 4,401 people waiting for an organ transplant. The law is expected to increase the number of organs available for transplantation, reducing the number of people waiting and saving more lives. A review comparing opt-out and opt-in countries found that opt-out consent increased deceased donations by 21-76% over 5-14 years and deceased transplantation by 38-83% over 11-13 years.
The impact of the opt-out law on transplant services was initially mitigated by the COVID-19 pandemic, which caused a reduction in transplantation rates. However, the pandemic also resulted in valuable organs being wasted, further affecting waiting lists. To address this, the Organ and Tissue Donation and Transplantation Directorate (OTDT) UK developed a second surge plan to maximise the number of organs available for transplantation.
Overall, the opt-out organ donation law in England is expected to positively impact transplant services by increasing the availability of organs and reducing waiting lists. However, it also presents challenges and increases the demand for efficient and well-resourced transplant services.
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Frequently asked questions
Yes, all regions of the UK have an 'opt-out' system for organ donation consent. This means that it is presumed that you are content to be an organ donor upon death unless you signal otherwise on the ODR (Organ Donor Register).
The opt-out system means that all adults in England will be considered as having agreed to donate their organs when they die unless they record a decision not to donate or are in one of the excluded groups. Excluded groups include those under 18, those who have lived in England for less than 12 months, and people who lack the capacity to understand the change.
The opt-out system was introduced by the Organ Donation (Deemed Consent) Act 2019 and officially came into force on 20 May 2020.
You can record your decision to opt out on the Organ Donor Register. If you prefer not to have your wishes recorded on the register, you must tell your family your donation wishes and ask them to honour them.
