Default organ donation was meant to save lives but 'opt-out' has been a fatal failure

As transplant waiting lists grow and donor numbers fall, experts say families shouldn't have the final say

- Martha Gill

Organ donation is in crisis. Right now, around 8,000 people are waiting for a transplant - a record number.

The number of donors, however, has been crashing: in the past year, 1,403 people gave their organs after dying, down 7% on the year before. As a consequence, many will die waiting for a phone call.

This dire state of affairs has been puzzling policymakers. Every adult is presumed to be a willing organ donor after death - unless they register to opt out (only a tiny fraction does). At the last count, in 2023, 2.5 million people - 3.7% of the population - had refused to give consent. Most people support organ donation in principle. So why aren't there enough organs to go around?

Until recently, those who wanted to donate their organs after death - or, less commonly, their skin or lungs - had to put themselves on the NHS Organ Donor Register. This great list is run by NHS Blood and Transplant (NHSBT), which is also in charge of matching and allocating organs, and keeping records, all under the watchful eye of the regulator, the Human Tissue Authority. But in 2020, MPs and campaigners succeeded in changing the law.

Rather than having to chivvy people into signing up - raising awareness and pulling on heartstrings - they would simply make it the default. When the rules for organs were altered, expectations were high. “It was imagined as a gamechanging policy,” says Leah McLaughlin, a research fellow at Bangor University. “The reality hasn't lived up to it.”