AUTHOR=Jansen N. E. , Williment C. , Haase-Kromwijk B. J. J. M. , Gardiner D. 

TITLE=Changing to an Opt Out System for Organ Donation—Reflections From England and Netherlands

JOURNAL=Transplant International

VOLUME=Volume 35 - 2022

YEAR=2022

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2022.10466

DOI=10.3389/ti.2022.10466

ISSN=1432-2277

ABSTRACT=Recently England and the Netherlands have changed their consent system for deceased organ and tissue donation from Opt In to Opt Out. The reflections shared in this paper give insight into this change and may be helpful for any other nation considering likewise.
Strong support in England for the change in legislation led to Opt Out being introduced without requiring a vote in parliament in 2019. In the Netherlands the Bill passed by the smallest possible majority in 2018. Both countries implemented a public campaign to raise awareness of the change in legislation and what action individuals should take. In England registration on the Donor Register is voluntary. Registration was required in the Netherlands for all 14 million residents 18 years and older. For those 7 million not already on the register, letters were sent by the Dutch Government to ask individuals to register their donation preference. If people did not respond they would be legally registered as having ‘no objection’ to donation. After implementation of Opt Out in England 42.3% of the population over 18 years is registered Opt In, 3.6% Opt Out, and 54.1% has no registration. In contrast in the Netherlands the whole population 18 years and older is registered with 45% Opt In, 31% Opt Out and 24% ‘No Objection’.  
It is too soon after implementation of the new laws to draw conclusions about the impact on the consent rate for donation and the number of resulting organ donors. However, the first signs are positive. One of the lessons learnt from the experiences in England and the Netherlands is that legislation won’t be successful in isolation. It is essential to have an established public awareness of organ donation. A change to Opt Out provides a powerful new opportunity for engagement.