Legislation passed in December 2015 in Wales, United Kingdom, has introduced a concept of “deemed consent” for organ procurement, which broadly states that individuals who neither opt-in or opt-out of organ donation are considered to not have an objection to organ donation upon death. This law was aimed at improving the rates of organ procurement for patients who require transplantation, an improvement which has been demonstrated following legislation enactment, as reported in the Journal of Medical Ethics.

The passing of the Human Transplantation (Wales) Act has placed Wales in the company of other European countries with similar deemed consent laws that are focused on organ procurement. Individuals may be categorized into 3 groups: (1) individuals who have registered for consent for organ donation, (2) individuals who have registered to not allow organ donation, and (3) individuals with deemed consent who have neither registered to opt in or out of organ procurement.

Currently, Welsh law protects the removal of organs from registered donors despite family objections. Despite this legislation, these objections are often satisfied by the avoidance of organ removal, which is prevalent in Wales as well as in the entire European Union. With the Human Transplantation (Wales) Act, organ procurement proceeds in patients unless credible evidence can be provided that demonstrates that the deceased did not want to participate in organ donation. Despite this rule, the family can overrule the deceased’s wishes.

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This controversial piece of legislature has produced a few potential issues. First, it’s theorized that the Act may result in a reduced sense of urgency in living donors, thereby reducing their number. Kidneys from living donors, for example, function better than those from deceased donors, and fewer living kidney donors may translate into worse outcomes in transplantees.

In addition, some believe that the new legislation will increase family refusals and cause more people to opt-out of consent, resulting in fewer deceased donors.

Close monitoring and studying of the Act’s effects are needed to determine its advantages and disadvantages in organ procurement.

Reference

Albertsen A. Deemed consent: assessing the new opt-out approach to organ procurement in Wales [published online February 1, 2018]. J Med Ethics. doi:10.1136/medethics-2017-104475