Organ Donation: Opt In and Opt Out Strategies


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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Saunders, Ben(Dec 2012) Organ Donation: Opt In and Opt Out Strategies. In: eLS. John Wiley & Sons Ltd, Chichester. [doi: 10.1002/9780470015902.a0024197]