Organ Donation: Opt In and Opt Out Strategies

Ben Saunders, University of Stirling, Stirling, UK

Published online: December 2012

DOI: 10.1002/9780470015902.a0024197

Opt-in strategies only take organs from those who have specifically consented to donation, whereas opt-out strategies treat everyone as a willing donor unless they exempt themselves. Both strategies allow individuals (or their next of kin) power to determine what happens to their cadaveric organs; the difference between them is the ‘default’ treatment of someone who has expressed no wish either way. Opt-out strategies are likely to increase donation rates, because those who do not register a preference either way will be treated as donors. Opt-out strategies are often called ‘presumed consent’ and critics contend that this is unjustifiable. In fact, numerous other justifications for such a policy are available, for instance it may be that those who do not opt out thereby tacitly consent to the use of their organs.

Key Concepts:

  • Opt-in donation strategies means no one's organs are used without their consent.
  • Opt-out donation strategies mean that everyone is treated as a donor unless they specifically refuse.
  • Few countries operate ‘pure’ opt-in or opt-out strategies, because consent is usually sought from next of kin.
  • It is difficult to measure or predict the effects of a change in policy, but likely that an opt-out strategy will procure more organs than an opt-in strategy.
  • An opt-out strategy should not be identified with ‘presumed consent’.
  • There are a variety of possible justifications for an opt-out strategy, including tacit consent and normative consent.
  • ‘Tacit consent’ means that one's consent is implied by one's silence.
  • Tacit consent does not necessarily meet the conditions of informed consent.

Keywords: bioethics; consent; opt in or opt out; organ donation; organ procurement; organ transplant; presumed consent; tacit consent

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    Taylor JS (2006) Personal autonomy, posthumous harm, and presumed consent policies for organ procurement. Public Affairs Quarterly 20(4): 381–404.
    book Wilkinson TM (2011) Ethics and the Acquisition of Organs. Oxford: Oxford University Press.

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Article Title: Organ Donation: Opt In and Opt Out Strategies
 
How to Cite close
Saunders, Ben(Dec 2012) Organ Donation: Opt In and Opt Out Strategies. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0024197]