Wales’ landmark opt-out organ donation law has had little impact – new research

Ten years after Wales became the first UK nation to introduce a soft opt-out system for organ and tissue donation, new research suggests the change has not delivered the hoped-for rise in consent rates.

On 1 December 2015, Wales introduced a deemed-consent model in which adults are presumed to have agreed to donate their organs after death unless they explicitly opt out.

At the time, ministers said the move would increase consent rates and save more lives.

But a decade later, researchers at Bangor University say the anticipated rise has failed to materialise.

Dr Leah McLaughlin, Research Fellow at the university’s School of Health Sciences, said consent levels fluctuate annually but are “no better now than when the legislation was introduced”.

“The anticipated increase in organ donation consent rates has not materialised,” she said. “Although the pandemic may have played a role, our research suggests that legislative changes alone are insufficient without addressing the underlying ethical tensions and the need for clear, compassionate communication with families during such difficult times.”

Over the past decade, Dr McLaughlin and Professor Jane Noyes, supported by the Wales Kidney Research Unit, have conducted multiple studies into the impact of opt-out and how families experience the donation process.

Professor Noyes said families often struggled with complex paperwork, lengthy procedures and confusion over what deemed consent actually meant.

“Many families we spoke to didn’t fully understand the concept,” she said. “Some struggled with the idea of their loved one undergoing surgery and lost sight of the potential lives saved through organ donation. The process can be overwhelming.”

The Bangor researchers say improving public understanding is essential, with many people still unaware that they are presumed to have given consent unless they opt out.

Online resource

To address this, Bangor University, in partnership with the London School of Hygiene & Tropical Medicine, has developed a new online resource to help families understand how deemed consent works.

Featuring real stories from bereaved families and healthcare staff, the tool is designed to reduce confusion and support more meaningful conversations.

The platform can also be used in training settings to help healthcare professionals navigate one of the most sensitive areas of clinical care.

Professor Noyes says reforms are still needed to increase donation rates. She argues the consent process should be simplified and that greater legal weight should be given to decisions made in life—such as joining the Organ Donor Register—to prevent family overrides.

“Healthcare professionals also need better training to support families effectively in what are often tragic circumstances,” she added. “Regular prompts encouraging people to update their preferences may further reduce uncertainty.”

Future clinicians

Bangor’s North Wales Medical School is also preparing future clinicians through specialist organ donation workshops. Delivered with Betsi Cadwaladr University Health Board and donor nurses from across Wales, they give medical students an early insight into the realities of donation from both donor and recipient families.

Fourth-year student Elinor Thomas described the session as “an extremely important experience”.

“We were given a glimpse into how organs are recovered and the profound impact donation has on patients and families,” she said. “It provided invaluable insight into a deeply emotional and sensitive subject.”