Study reveals impact of 'soft opt-out' system for organ donation

Research published in Anaesthesia suggests that a "soft opt-out" system may increase consent rates for organ donation after death, which could boost the number of organs available for transplantation.

The legal frameworks for consent for deceased organ donation fall into two major categories: opt-in, where expressed consent is required from the patient or their relatives, and opt-out, where consent is presumed in the absence of a statement made by the patient in their lifetime to the contrary. An opt-out system of consent was introduced in Wales in December 2015. While the legislative change in Wales provides a legal basis for deeming consent, the family are still asked to support organ donation proceeding—a system known as soft opt-out. England maintained the existing opt-in system through the study period.

To examine the effect of Wales' change in policy on organ donation, investigators compared quarterly data on consent rates for deceased organ donation in Wales versus England from January 2016 through December 2018.

By the end of the study period, the chance of consent to organ donation in Wales was 2.1 times higher than in England and 2.8 times higher in patients who had made no prior donation decision in life.

"We observed that organ donation consent rates in Wales significantly increased in comparison with England, although the impact was not immediate and took several years to take effect," said author Phil Walton, Project Lead for Deemed Consent Legislation, NHS Blood and Transplant, UK. "Following an extensive marketing campaign in Wales, Specialist Nurses reported that in most conversations the families were expecting to talk about organ donation and were prepared to explore the options available to them."

The findings are especially timely because the law around organ donation is changing in England, and an opt out system is being rolled out on May 20, 2020.