organ donation page on laptop

Opt-out organ donation is just a placebo

6th Nov 2018 - Rachael Adams

Today CARE for Scotland Parliamentary Officer, Dr Gordon Macdonald gave evidence to the Health and Sports Committee on why the Government’s proposals to change to an opt-out system for organ donation is just an expensive distraction. 

The evidence does not back up claims that an opt-out system would significantly alter organ donation rates in Scotland, in fact it diverts scarce resources away from measures that have been specifically proven to increase donation rates. 

The Nuffield Council on Bioethics have demonstrated that the presence of a specialist nurse in organ donation increases the donation rate from 27.5 per cent to 68.6 per cent. 

One of the main ethical challenges is to make sure that we use the limited resources we have in the most effective way possible to maximise donation rates. The costs of changing the organ donation system in Scotland and then the successive awareness campaigns to make sure citizens are aware of the new system and their rights would take away scare resources from measures proven to increase organ donation rates.

Wales has changed its own law to one of presumed consent in 2015, but an increase in organ donation has not followed.

The most successful country in the world for organ donation, Spain, has rejected claims that it runs an opt-out system. They claim that the law  change did not lead to a significant increase in organ donations. Instead they used money to fund training medical professionals in procedures regarding organ donation and awareness campaigns encouraging people to donate. An article in the British Medical Journal refers to opt-out as ‘an expensive distraction.’

CARE for Scotland Parliamentary Officer Dr Gordon Macdonald said:

“Waiting for an organ donation can absolutely agonising because you never know when the right organ might become available and it is right to seek ways to increase organ donation levels.

“CARE understands the desire to increase organ donation levels and we have always argued that we should be doing so in an ethically responsible way and in a way that is proven to be effective.

“In this connection, the Government’s plans to move to an opt-out system are deeply concerning.

“Scotland has been much more successful than other parts of the UK in encouraging people to opt-in to donate their organs.

“It does not make any sense why the Scottish Government is proposing to introduce an opt-out system when it has made significant progress in increasing the rates of deceased organ transplants and the claimed benefit of an opt-out system is unproven.

“In fact, it diverts money away from measures that have been proven to work in increasing the number of organs available for transplantation.

“Instead of spending millions of pounds on introducing presumed consent or 'deemed authorisation' (as the Scottish Government refers to it), where there is little or no evidence of success, the Scottish Government should increase the number of specialist nurses in organ donation. This has been proven to increase organ donations.

“That’s why we are calling on the Government to instead recruit more specialist nurses because we believe this is one measure that is proven to help increase the number of organ donations.”


Notes to Editors:

For more information please contact Rachael Adams on 020 7227 4731 / 07851 153693 or

CARE for Scotland’s evidence to The Health and Sport Committee on the Human Transplant (Authorisation) (Scotland) Bill was streamed live on BBC Parliament here:

Above is a photo of Dr Gordon Macdonald giving evidence to the Health and Sports Committee on organ donation - 06.11.2018

Scottish Government’s information on Organ Donation and Transplantation

More information on the Human Tissue (Authorisation) (Scotland) Bill

‘An expensive distraction’ - opt out donation and Spain:

In an article for the British Medical Journal written by leading organ donation experts Prof John Fabre, Paul Murphy and Rafael Matesanz, the point is made even more starkly. Entitled ‘Presumed consent: a distraction in the quest for increasing rates of organ donation,’ the article states:
‘Crucially, Spain does not have an opt-out register for those who do not wish to become organ donors. Not a penny is spent on recording objections to organ donation by Spanish citizens, nor on public awareness of the 1979 legislation.’  -    BMJ 2010;341:c4973.

This September to coincide with Organ Donation Week CARE launched a week-long campaign on organ donation to increase awareness of organ donation and encourage people to think about whether people would like to become organ donors.

CARE has repeatedly warned that an opt-out system may not work:  CARE on BBC Radio Scotland talking about why an opt-out organ donation system may not lead to an increase in organ donationsCARE on BBC Radio Cumbria on why opt-out organ donation doesn't work and CARE on Sky News warns of opt-out organ donation policy.

Organ donor opt-out system 'unlikely' to increase donations

Govt opt-out organ claim based on 'uncertain estimates'

Wales' organ donation opt-out law has not increased donors – BBC News

The Nuffield Bioethics Council said last year that there should be an increase in specialist organ donation nurses:

Scottish Government’s own policy memorandum:

Paragraph 30 of the Scottish Government’s policy memorandum on international evidence of organ donation says: "International evidence suggests that opt-out legislation can be effective as part of a package of measures to increase organ donation, however, there is insufficient robust evidence to conclude that opt-out legislation alone will increase deceased donation. The evidence highlights the importance of a range of non-legislative measures, which can work effectively in their own right to increase donation and transplantation and which are often associated with successful optout systems. International evidence highlights that there is an association between countries with opt-out legislation and people‘s increased willingness to donate their organs, as well as an association with increased deceased donation.  Despite this association, there is limited robust evidence that shows soft opt-out organ donation causes increases in deceased donation." Para 30

 Organ Donation Transplants table:  

Deceased Organ Donor Transplants 2014/15-2017/18





















Northern Ireland





Source NHS Blood and Transplant[1]



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