Max and Keira's Law: Can the opt-out system increase the number of organ donors?

Gemisha Cheemungtoo

20th May 2020 marked the enactment of the Organ Donation (Deemed Consent) Act 2019 in England, or often referred to as 'Max and Keira's Law'. The name transpired from the campaign a family ran in favour of the opt out system, after their young boy, Max received a life-saving heart transplant from Keira, a girl who tragically lost her life in a road traffic accident. 
 
In this new law, the organ donation system has been changed to consider that most adults have agreed to donate their organs unless the person opted out before their death, and this is done with the family's consent. The law excludes the following groups from the register: 
Under 18s, who cannot be considered as adults 
People who lack the mental capacity to make this decision
People who are living in England involuntarily, or for less than 12 months 
 
This new system has been approved to increase the supply of donors for the patients awaiting a transplant, which at the time of writing, is at 2634. According to Health Minister Jackie Doyle-Price, the policy could "save as many as 700 more lives every year". Although the legislature is likely to generate important discussions about organ donation at present, will it actually increase the numbers in the long term?
 
Out of the four nations, Wales was the first country to successfully implement a soft opt-out register from 2015 - a soft opt-out meaning that donations are only made after consultation with the person's family. Scotland will also be enforcing a similar system from March 2021, however, lobbying for a change from the opt-in system in Northern Ireland continues. 
 
A study that looked at the short-term effect of the organ donation system in Wales after the introduction of its opt-out legislation, found that organ donation registration rates increased from 34% to 38%. However, there was no direct relation between the increase in Welsh consent rates and the change in legislation. After 21 months since the implementation of the legislation, the number of deceased donors had decreased, from 104 to 101. These results show that changing the policy alone may not attribute to a greater number of donors. 
 
Yet, hope is not to be lost. The study's authors have suggested that along with further longitudinal monitoring of data, supplementary interventions are needed alongside the law change, in order to create a mass shift in attitude. Experts criticising the soft opt-out approach have pushed for two major strategies proven to improve transplant rates: public campaigns in favour of donation and opening conversations about becoming donors, as well as training specialist staff for those conversations.
 
The main takeaway from this all is that this new legislation should not be relied upon as the one-stop solution to meeting the shortage of organ donors. Instead, it should act as the catalyst of public education, and be supported by campaigns that can evoke emotion from strangers and put faces to causes. In the end, it might be up to cases like Max and Keira's, who propagated this very law, to help unlock the altruistic potential of donors from the public and save lives. 
 
https://www.organdonation.nhs.uk/helping-you-to-decide/real-life-stories/families-who-donated-their-loved-ones-organs-andor-tissue/keiras-story-max-and-keiras-law/
https://www.organdonation.nhs.uk/helping-you-to-decide/about-organ-donation/faq/what-is-the-opt-out-system/
https://www.organdonation.nhs.uk/helping-you-to-decide/about-organ-donation/statistics-about-organ-donation/
https://bmjopen.bmj.com/content/9/4/e025159
https://fullfact.org/health/could-opt-out-organ-donation-save-700-lives-year/
https://www.organdonationscotland.org/news-events/human-tissue-authorisation-scotland-act-2019-%E2%80%93-update
https://www.bma.org.uk/advice-and-support/ethics/end-of-life/organ-donation

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