The impact of presumed consent for organ donation on donation rates


As part of its work, the UK Organ Donation Taskforce commissioned CRD to undertake a systematic review. The primary objective of the review was to examine the impact of presumed consent legislation on organ donation rates by identifying, appraising and synthesising empirical studies that examined the impact of having a presumed consent or opt-out system. The secondary objective was to identify, appraise and synthesise data on attitudes of the public, professionals and any other stakeholders to presumed consent.


The systematic review combines 26 previous studies and public opinion surveys and represents the most comprehensive review to date examining the impact of having a presumed consent or opt-out system.

The existing evidence, albeit somewhat methodologically limited, suggests that presumed consent legislation is associated with an increase in organ donation rates, though the size of the association varied between studies.

The evidence also suggests that presumed consent alone is unlikely to explain the variation in organ donation rates between different countries. A number of other factors appear to be associated with organ donation rates, though their relative importance is unclear. These factors include deaths from causes most likely to provide organ donors, the transplant coordination infrastructure, the wealth and health expenditure of a country, religion, education, and the legislative system.

Underlying public attitudes about organ donation and systems of consent and support structures for the dying and their families are also likely to be important and the review assessed public and professional attitudes to presumed consent.

The survey evidence is incomplete and the variation in attitudes between surveys may reflect differences in methods and the phrasing of questions. Some surveys suggest a lack of public support both in the UK and elsewhere, though the more recent UK surveys do suggest public support for presumed consent.

Conducted by: Amber Rithalia1, Catriona McDaid1, Sara Suekarran1, Gill Norman1, Lindsey Myers1, Amanda Sowden1

1. Centre for Reviews and Dissemination

Further details

Project page on the NIHR HTA Programme website


Rithalia A, McDaid C, Suekarran S, Myers L, Sowden A. Impact of presumed consent for organ donation on donation rates: a systematic review. BMJ. 2009;338:a3162

Rithalia A, McDaid C, Suekarran S, Norman G, Myers L, Sowden A. A systematic review of presumed consent systems for cadaveric organ donation. Health Technol Assess. 2009; 13(26): 1-118

Rithalia A, McDaid C, Suekarran S, Norman G, Myers L, Sowden A. Systematic Review of Presumed Consent Systems for Deceased Organ Donation, Centre for Reviews and Dissemination, University of York. Supporting Information In: The potential impact of an opt out system for organ donation in the UK: A report from the Organ Donation Taskforce. 2009


Commissioned by the NIHR HTA programme as part of the Technology Assessment Report (TAR) process