New bill seeks to introduce soft opt-out organ donation


The Scottish Government has today published a new bill which will introduce a new soft opt-out system of organ and tissue donation in Scotland. 


The Human Tissue (Authorisation) (Scotland) Bill will change organ and tissue donation from the current opt-in system to an opt-out system. Under the new proposals authorisation will be presumed for organ/tissue donation for those who have not opted out. Close relatives and next of kin may still be able to stop a donation where it can be shown that it was not the deceased’s wishes that their organs be donated. Hence, the term ‘soft’ to describe the new system.  


The Church submitted a response to the Scottish Government’s consultation in 2017 and made it clear that the Church acknowledges the ‘need for more organs to be donated to allow those who are suffering the opportunity to enjoy a better quality of life.’ We also stated that the Church ‘sees organ donation after death as a noble and meritorious act to be encouraged as an expression of generous solidarity. It is a gift and a sign of great love for one another.’


But whilst the Church will always encourage the generous gift of organ donation it is concerned that in an opt-out system of organ donation the gift of an organ or tissue is not necessarily freely given. An opt-out system undermines the nature of gift by presuming consent instead of seeking explicit consent as is the case under the current opt-in system.  


The Church would like to see the introduction of new initiatives to encourage people to donate, similar to those introduced in Spain in 1989. Spain has significantly higher rates of organ donation in Scotland, and although an opt-out system has been in operation since 1979, it wasn’t until Spain decided to proactively encourage organ donation in 1989 through a national public campaign and the creation of the Organizacion Nacional de Transplantes (ONT), that donor numbers increased. The ONT is a technical agency in charge of the coordination and oversight of donation and transplantation activities in Spain, and it created a model of coordination in deceased donation that made the country evolve from 15 donors per million population to more than 30 per million. It did this by relying on designated professionals and coordinators based in every hospital who were responsible for organ donation. This coincided with a greater focus on education and a massive advertising campaign to highlight the importance of organ donation. These changes worked and Spain became a world leader in organ donation. 


In summary, Spain had been operating a system of presumed consent (or opt-out) for a period of ten years prior to the changes to the infrastructure detailed above without any significant effect on rates of donation. However, a significant increase in donations followed the practical, organisational changes made by the Spanish government. In the end it was the changes to the organisational structure of organ donation, rather than the formal introduction of a system of presumed consent, that brought about a greater increase in donations. 


To emphasise this point, Wales introduced a soft opt-out system of organ donation in December 2015 and since then numbers of transplants have not increased.