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Presumed consent for organ donation

Posted on 15 January 2009

Introducing presumed consent or opt-out system may increase organ donation rates, suggests a new systematic review published on today.

There is currently insufficient supply of donor organs to meet the demand for organ transplantations in the UK. The number of patients registered for a transplant continues to increase. In March 2008, 7,655 patients were on the active transplant list; 506 died in 2007-2008 while waiting for their transplant.

At present the UK has an informed consent legislative system where individuals opt-in if they are willing for their organs to be used after death. However, only a quarter of the UK population are on the NHS donor register.

The review, carried out at the Centre for Reviews and Dissemination (CRD), University of York, 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 are also likely to be important and the review assessed public and professional attitudes to presumed consent.

Dr Catriona McDaid said: “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.”

Further information can be obtained from Alison Booth or Paul Wilson, Tel: 01904 321040; email:

Notes to editors:

  1. Amber Rithalia, Catriona McDaid, Sara Suekarran, Lindsey Myers, Amanda Sowden. The impact of presumed consent for organ donation on donation rates: a systematic review. BMJ 2008
  2. The systematic review was conducted by researchers from the Centre for Reviews and Dissemination and commissioned by the NIHR HTA programme on behalf of the Department of Health Policy Research Programme to inform the work of the UK Organ Donation Taskforce. The views expressed in the review are those of the authors and not necessarily those of the Department of Health, NIHR HTA, Policy Research Programme or the UK Organ Donation Taskforce.
  3. The Centre for Reviews and Dissemination is part of the National Institute for Health Research (NIHR) and is a department of the University of York. The Centre aims to provide decision makers with research-based information about the effects of interventions used in health and social care. For more information visit:
  4. Health Services Research at the University of York has been ranked joint top in the new Research Assessment Exercise published 18th December. The RAE assessment of Health Services Research is based on a joint submission from the Department of Health Sciences, Centre for Health Economics and CRD. The University of York is one of the UK's top 10 research universities.
  5. If publishing online, please carry a hyperlink to the CRD website: