Organ donation in the UK

What is organ donation in the UK?

Organ donation is the process whereby someone donates or gives an organ to someone in need of a transplant. The removal and placement of organs from one person to another is performed via surgery.

There is an overwhelming demand for organs every year due to various conditions. As a result, organ donation saves lots of lives every year in the UK!

What are the groups of people that typically end up donating?

Individuals who suffered from an acute brain injury due to a stroke or trauma, resulting in brain death
Individuals who have died in a hospital intensive care unit or emergency department

Current law in the UK relating to organ donation

The organ donation law had changed in England from the ‘opt-in’ system to the ‘opt-out’ system the ‘opt-out’ system. The ‘opt-out’ system came into effect in 20th May, 2020 and it also referred to as the ‘Max and Keira’s Law’.

What is the ‘opt-in’ system?

The ‘opt-in’ system requires individuals to give clear and explicit consent whilst they were alive, or alternatively, requires the individual’s family to give consent for being an organ donor.

What is the ‘opt-out’ system?

The ‘opt-out’ system indicates that all adults in England are considered an organ donor upon death unless they have explicitly stated that they do not wish to be an organ donor, or alternatively, belong to one of the following groups:

individuals under 18
individuals who resided in England for less than 12 months
individuals who are not voluntarily living in England
individuals who do not have the capacity to comprehend and understand the change of system surrounding organ donation

It is important to note that this ‘opt-out’ system also takes into account one’s wishes as to whether they would like to be an organ donor so people still have a choice, as well as choosing which organ(s) they would like to donate. Furthermore, the individual’s family would be involved (if they wish to be) before the organs are donated.

Exclusion criteria for donation

In order to be eligible for organ donation after death, the individual is required to die in a hospital under specific circumstances and their eligibility is determined by specialist healthcare professionals.

There is no age limit in order to register to become an organ donor, though there are several medical conditions that would rule out organ donation completely:

Creutzfeldt-Jakob Disease (CJD)
Ebola virus disease
Active cancer
HIV

Process of confirming death in the UK

In the UK, death is typically confirmed by clinicians who are separate to and independent of the organ transplantation team regardless of whether the individual is an organ donor. The NHS Organ Donor Register will be checked to see if the individual has registered to opt-out of organ donation or has made any requests or amendments, and their family will always be consulted on the matter.

In order to confirm death and for the individual to become an organ donor, clinicians must determine and confirm circulatory death – where the individual’s heart no longer beats – or brainstem death – where the individual’s brain show no exceptional brain activity and this is determined by a set of predetermined criteria.

Donation after Circulatory Death (DCD)

DCD is also known as donation after cardiac death and it refers the removal of organs from the organ donor postmortem where their death is confirmed using predetermined cardio-respiratory criteria. There are 2 main types of DCD – controlled DCD and uncontrolled DCD. Controlled DCD typically takes place after the death of an organ donor due to planned withdrawal of life-sustaining treatments. On the other hand, uncontrolled DCD refers to the unexpected passing of an individual post cardiac arrest and unsuccessful resuscitation attempts.

Donation after Brainstem Death (DBD)

Donation after Brainstem Death refers to individuals whose death is determined based on a set of predetermined neurological criteria, indicating inactivity of the brainstem which is essential in sustaining life. This particular type of confirmation of death is only possible in individuals who are reliant on mechanical ventilation. The set of neurological criteria for the confirmation of death of the individual is applicable to instances of brain injury which has led to irreversible brain damage. It is, effectively, a state of permanent coma (lack of consciousness or awareness) and an inability to breathe unaided. This is demonstrated by a lack of fundamental brain stem nerve reflexes.

This type of donation is more common than DCD due to factors such as having more time for discussion between family members and clinicians and consent, as well as the organs would be more likely to be in a better state due to better perfusion.

Legal and Ethical controversies

‘Hard’ vs. ‘Soft’ Opt-out System

A ‘hard’ opt-out system is where the individual’s family is not consulted regarding the deceased’s wishes with regards to being an organ donor. The deceased is presumed to have consented to be an organ donor. A ‘hard’ opt-out system is practiced in Singapore and Austria, contrary to the ‘soft’ opt-out system used in England, North Ireland, and Wales (though Scotland is still using an opt-in system). A ‘soft’ opt-out system is where the family members of the deceased are consulted regarding the process of organ donation and their opinions taken into account and honoured.

Ethical Issues

Despite the significant moral good that having an opt-out system in place for those in dire need of new organs, it is essential for the process whereby organs are removed from the deceased to be morally acceptable. To put it differently, the ultimate goal – increase in organ donations from the public – should not be viewed as justifying the means of obtaining the organs. Therefore, it is important that there is a process in place to ensure that there is a maximum number of organs obtained via morally acceptable and ethical means. For instance, given the strong moral implications in support of being an organ donor, people may feel pressured to become an organ donor, which might not correspond to their personal beliefs. Consequentially, it is crucial to engage the public in such a way that encourages to make a private choice, based on their own beliefs, as to whether they’d like to be an organ donor.

How do you become an organ donor?

Interested in becoming an organ donor? Follow the following steps:

Gain a better understanding of the opt-out system in the UK. (More detailed information can be found at www.organdonation.nhs.uk)
Make sure that you do not belong to one of the aforementioned excluded groups.
Register to become an organ donor via this website: https://www.organdonation.nhs.uk/register-your-decision/donate/?
1. If you would like to donate only some organs, you can still register your decision and preferences on the website above.
2. If you recorded your decision on the NHS Organ Donor Register and would like to make some changes and alter your details, you are able to amend your details via filling out this form: https://www.organdonation.nhs.uk/register-your-decision/amend/
Once you have recorded your decision, regardless of what you decide, do have a chat with your family and loved ones. Clinicians will always consult them and they are able to overturn your decision if they believe that your previously recorded decision might not be what you want.
1. When the family is consulted, their wishes aren’t necessarily honoured. However, in practice, it would be incredibly rare for the clinicians to proceed with the donation if the family had voiced specific objection