'Opt-out' organ donation scheme may lead to fewer transplants, experts warn

The new opt-out organ donation scheme may backfire, researchers have warned, because families will not know if loved ones really intended for their body parts to be used.

Under plans confirmed by the government this month, adults will be presumed to be organ donors unless they have specifically record their unwillingness to donate from 2020.

The change has been dubbed Max's Law, after 10-year-old Max Johnson, whose family campaigned for changes after his life was saved by a heart transplant.

Health ministers claim it will save up to 700 lives a year, but researchers at Queen Mary, University of London, say it could actually lead to fewer organs being available for use.

Dr Yiling Lin, of Queen Mary’s Dynamic Learning & Decision Making Laboratory, said: “What we show is that this system is unlikely to increase actual rates of organ donation, all it will do is increase the number of people on the organ donation register.”

The problem with the proposed plan arises because organ donation schemes include a clause that allows the final decision to be made by family members.  

NHS Blood and Transplant reported that more than 500 families have vetoed organ donations since April 2010, leading to 1,200 people missing out on potential life-saving transplants.

New research by Queen Mary shows that that the number of vetoes is likely to increase in a system where no explicit consent was given in the first place.

In experiments more than 1,000 participants from countries with opt-in or opt-out systems were asked to judge the likelihood that an individual’s ‘true wish’ was to donate their organs.

Those from opt-out countries were less likely to believe an individual had really consented.

Lead author Dr Magda Osman, who runs the laboratory, said: “If you have an organ donation register that presumes consent, then it is harder for a third party to tell if you being on the register reflects what you genuinely intended.

“As it is, family veto rates are high in systems where there is an opt-in system, so by implication, our findings suggest that veto rates would certainly not fall as a result of introducing an opt-out system, if anything it would create greater problems, particularly ethical ones.”

In 2017/18 there were 6,044 people in the UK waiting for a transplant and 411 patients died while waiting.

Shortages have been caused because people are generally living longer and improvements in medicine mean fewer people now die from accidents.

Wales introduced an opt in system in 2015 but it has not increased donations. However legislation to bring in the same scheme in England is expected to be passed in the next parliament.

Dr Osman added: “Our findings are important because they challenge the efforts of many nudge enthusiasts to promote the use of opt-out defaults in organ donation.

“To help increase actual rates of organ donation, we need more transplant coordinators working with families to help them understand the issues before being faced with a monumental and distressing decision.

“We also need to offer people a way to indicate explicitly what they wish to do. This should involve an expressed statement of intention if their wish is to donate, or an expressed statement of intention if there is an objection to donate.

“This reduces the ambiguity in trying to infer what one wanted to do when it comes to donating their organs.”

The study was published in Journal of Experimental Psychology: Applied.