Organ Donation: Opt-in v opt-out

Becky Moles

This week, Assembly Members voted in favour of a presumed consent system for organ donation in Wales, the implication being that citizens will have to opt-out of automatically donating their organs when they pass away.

This has been an extremely bold and controversial move, rousing debate from both those who are for and against organ donation in general, as well as the move to an opt-out system.

The main benefit of organ donation is quite simply, saving lives. Situations can arise whereby no treatment can save an organ, and the only option in order to live is to replace it with a healthy one. There are currently over 10,000 people in the UK who are in need of a transplant. So what’s the issue with donating an organ when we die? We clearly don’t need it anymore, and if it enables another human being to have a chance at life, then some struggle to see how that could ever be a bad thing. An opt-out system would increase potential donors and thus save more lives. But the debate is of course not as black and white as that.

The NHS’s position on organ donation is – ‘Would you take an organ if you needed one? Nearly everyone would. But only 31% of us have joined the Organ Donor Register’. They estimate the percentage of people that would accept an organ if they needed one to be 96%. But does the word ‘donation’ not imply ‘to give of one’s own free will?’ If the consent is assumed then this is no longer a donation, and those who are in recipient of an organ may feel differently about receiving it if they know that the organ may have been taken against a person or their family’s will.

What if people do not get around to opting out before they pass away? This could potentially create a great deal of upset for the family. And what about people who may not have the capacity to understand the system and its implications for after they die? Is it right that a person would be subject to donating their organs if this is not something that they can comprehend? Furthermore, the opt-out system would also bring to prominence the issue of religion, as some religions do not allow organ donation or receipt.

Five years ago in England, a taskforce recommended against an opt-out system, and some commentators have cited this for evidence as to why we won’t be following in the footsteps of the Welsh with this scheme. But five years have passed and perhaps this move in Wales will lead to a shift in culture. This is an interesting and emotional debate which will no doubt continue, and only time will tell if we are to follow suit.

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