Wednesday, April 7, 2021

Organ donation in England: what will be the effect of "soft opt-out"?

 Here's an article arguing that the shift from opt-in deceased organ donation to opt-out plus family consent may not be a big one unless communication between clinicians and bereaved families is improved.

Khiroya H, Sharif A, Jones J, Willis D. Will the unusual become usual? A new legal change that aims to increase discussions around organ and tissue donation in England. Future Healthc J. 2021 Mar;8(1):e170-e173. doi: 10.7861/fhj.2020-0098. PMID: 33791502; PMCID: PMC8004295.

Abstract: "UK guidelines recommend that discussions about organ and tissue donation are conducted as part of end-of-life care. However, there are several barriers to discussing organ donation, and this is reflected in a critical shortage of donors. This article explores who should start the conversation about donation and how all healthcare practitioners can maximise their communication skills to have success in this area. It is particularly pertinent to be upskilled in this area in light of the recent legal change in England, where the system moved from an opt-in to a ‘soft’ opt-out one. Based on a similar legal change that took place in Wales and global data, it is unlikely that the legal change alone will prompt an increase in donation rates in England. This article proposes suggestions to increase awareness and conversations among healthcare professionals and patients with education, public health campaigns and interventions rooted in psychological theory."

"Despite major changes in the infrastructure for organ donation in the UK since 2008, there are not enough donated organs to meet the current need.5 Only 1% of annual deaths in the UK occur in circumstances where the deceased could be a potential donor.6 Identification and availability of sufficient donor organs are are major barriers for transplantation, but the most important barrier is widely acknowledged as failure to secure consent for organ retrieval.

"Black, Asian and minority ethnic (BAME) groups have low rates of deceased donation, which results in significantly longer waiting times for transplantation when compared with white patients.17 Low rates of donation are due to uncertainties around religious permissibility and a lack of trust in healthcare professionals by BAME patients, coupled with clinicians’ lack of confidence in communicating with and supporting BAME families.18 There is evidence to suggest that discussing topics such as organ donation and end-of-life care is more acceptable to BAME groups if conversations are conducted by members of their own community.


"The law changed in England on 20 May 2020, with organ and tissue donation moving from an opt-in to a ‘soft’ opt-out system.27,28 All adults in England are now considered to be potential organ donors when they die and family permission to proceed will be sought, unless they have previously recorded a decision not to donate organs, or are in one of the excluded groups.


"In December 2015, a similar legal change took place in Wales where the system is ‘deemed consent’. This means that if a person has not recorded an opt-in or opt-out decision, it is considered that they have no objections towards organ and tissue donation.


"The opt-out system has been received positively in Wales with 71% of the Welsh public saying they were in favour of it 1 year after the change in legislation.35 However, positive attitudes among the public and increased knowledge among healthcare professionals have not translated to a rise in donors.


"On a global scale, the data on organ and tissue donation between opt-in and opt-out countries draw ambivalent conclusions due to dated studies and heterogeneous methodology. Confounding variables include varying economies, public health campaigns and cultural attitudes towards donation. A recent study looking at 35 countries demonstrated no significant difference in deceased organ donation or solid organ transplantation between opt-in and opt-out countries.38 This is in keeping with the short-term data that we have from the recent law change in Wales.35,36 Given that the law change itself may not make a difference in England, it is worth thinking about future avenues in education, public health and psychology that can enhance the impact of the new opt-out system."

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