Attitudes to organ donation in Wales

The Human Transplantation (Wales) Act 2013 (the Act) introduced a ‘soft opt-out’ system of organ donation. In an ‘opt-out’ system presumed consent means that unless the deceased person has expressed a wish in life not to be an organ donor then consent will be assumed (or deemed in Wales).

The purpose of the Act is to make it easier for people to donate their organs to benefit patients.

The Act is central to the Wales Action Plan, which sets out a programme of continuous improvement on all aspects of organ donation and transplantation to deliver the NHS Blood and Transplant (NHSBT) strategy ‘Taking Organ Transplantation to 2020’.

The overall target of the strategy is to increase United Kingdom (UK) consent rates to 80% by 2020.

Under the former ‘opt-in’ system, in 2012/13, 2013/14 and 2014/15 only 50.3%, 53.6% and 48.5% of families consented to deceased donation in Wales.

In contrast the consent rate in Spain, which operates an ‘opt-out’ system in which all citizens are automatically registered for organ donation unless they choose to state otherwise, ranged between 80-85%.

The Human Transplantation (Wales) Act 2013 constitutes one of the biggest changes to the partnership and social contract between the Welsh Government and the people of Wales.

The Act is however controversial and not everyone consulted agreed with the ‘soft opt-out’ system and its principle of deemed consent.

Potential donor families are considered to be most affected by the Act as, unlike the old ‘opt-in’ system, their role in the ‘soft opt-out’ system remains essential but changed by deemed consent. Family member(s) are no longer the decision maker with regards to organ donation.

Family members are expected to put their own views aside and to support the decision made in life by the deceased person: whether the deceased person, opted in/out on the organ donor register, talked about it with a relative, appointed a representative, or in Wales did nothing – deemed consent.

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