Analysis: it's proposed to introduce an opt-out organ donation model to deal with shortage of organs available for transplant here

Last year, 18 heart transplants, five pancreas transplants, 28 lung transplants, 56 liver transplants and 127 kidney transplants took place in Ireland from organs donated by deceased donors. Alongside this, 40 living donors providing kidneys for transplantation. Such transplants can radically change lives of organ recipients and are often life-saving.

Yet, deceased organ donation remains rare in Ireland with an average of 80 multi-organ donors from the approximately 30,000 deaths each year in Ireland. A shortage of organs available for transplant exists in Ireland with around 600 individuals awaiting transplants in early 2019. For example, the median waiting time for a kidney transplant in Ireland is 22 months and 429 individuals awaited kidney transplants at the end of 2018.

To help address this issue, it has been proposed that Ireland would move to an opt-out organ donation model. An opt-out model for donation is where a person is presumed to consent to donation for transplant after their death unless they have registered an objection to donation on an opt-out register when they were alive. It is also called a "deemed consent"model.  

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From RTÉ 1's Six One News, a report on the "opt-out" donation model included as part of a new Government bill

Proposals to adopt this model were outlined as part of the General Scheme of the Human Tissue (Transplantation, Postmortem, Anatomical Examination and Public Display) Bill 2018 published last May. The "General Scheme" is essentially an outline of the proposed Bill and provides information on the main changes proposed. The Bill is expected to be published in the coming months and was discussed by the Joint Committee on Health last week. 

The model proposed is that the deceased’s family members would be consulted on the donation if the deceased did not register their wish to opt-out (a "soft" opt out model). If a designated family member objects to donation, no donation can take place. The designated family member is essentially the closest family member to the deceased at the time of death as specified in the General Scheme. For example, it could be a spouse or civil partner, co-habitant, child etc.

Under the proposal, the designated family member must confirm that they do not object to the donation of organs from the deceased before organ retrieval can begin and this must be witnessed. Deemed consent will only apply to the donation of liver, lungs, pancreas, heart and kidneys and only applies in the case of adults and not children.

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From RTÉ Radio 1's Drivetime, Della Kilroy talks to families impacted by organ donations.

It does not apply to adults who have not been ordinarily resident in Ireland for less than one year prior to death. This is a likely safeguard as such individuals may not be aware of the opt-out system in place. The system of deemed consent also does not apply to individuals who, for a significant period of time before their death, lacked capacity to understand consent could be deemed if they did not register their objection to donation. Any individual can also register an objection to donation during their life-time on an opt-out register which will be established. If an individual does so, then no donation can take place. 

The proposal follows recent moves towards opt-out systems elsewhere. Countries which operate such a system include Wales (where the Human Transplantation (Wales) Act 2013 introduced an opt-out system in 2015); England (the Organ Donation (Deemed Consent) Act 2019 provides for an opt-out system which will take effect from Spring 2020), and Scotland (the Human Tissue (Authorisation) (Scotland) 2019 was passed in July 2019 and an opt-out system for donation is expected to come into effect from autumn 2020). 

But adopting an opt-out system alone will not necessarily increase donations. Instead, recent studies suggest that ongoing programmes are needed to develop public understanding of organ donation to achieve increased donation rates. Any move towards an opt-out system also needs to be accompanied by education campaigns raising awareness about organ donation and by investment in the infrastructure and personnel required to deliver organ transplant services.  

Adopting an opt-out system alone will not necessarily increase donations

Opt-out systems can also raise ethical questions particularly around the adequacy of deemed consent including whether everyone knows how the laws work. Such issues can be addressed by ensuring widespread public information and education campaigns before any system takes effect. The public should be informed about the changes in the law, what a deemed consent model means, how to register an objection and the benefits of donation. 

It also is important that individuals are encouraged to discuss donation with their loved ones. If someone wishes to donate their organs for transplantation after their death, family members should know this to help fulfil their intention.


The views expressed here are those of the author and do not represent or reflect the views of RTÉ