Why we can’t use opt-out to harvest organs

By Mustafa Qurashi

The Organ Donation Act 2019 changed UK deceased organ donation policy: since May 2020, anyone who dies without opting out of the organ donor register may have their organs harvested for transplantation. The one-year buffer was designated to ensure high levels of public awareness of the change and of the option to opt-out. However, in my own experience, it has been quite uncommon to find that someone knows that changes in the system have occurred and also understands the consequences of ‘choosing’ not to opt out. When the Act received royal assent in 2019, a survey showed that 20% of people definitely did not want to donate their organs after they died. Yet since then, fewer than 3% of people have actually opted out of the register, indicating that many who previously objected remain effectively opted in without realising or, for whatever reason, have been unable or unwilling to express their desire to opt out.

I recently wrote a paper entitled ‘Opt-out paradigms for deceased organ donation are ethically incoherent’ as I believe it’s wrong to harvest someone’s organs without first asking. To me, this seems fairly obvious; human beings, dead or alive, possess a certain dignity that provokes an aversion to the idea of non-consensual organ procurement, just like the aversion to ideas of body snatching or the desecration of remains. Many of the arguments that justify dismissing these concerns by defending non-consensual organ procurement feel like sophistic and ultimately inadequate excuses for a violation that is intuitively quite clear.

In my paper, I argue that we have rights against bodily violations after death and that this creates a requirement for explicit consent from potential organ donors before they die. I also address the idea that the sick could be entitled to the organs of the dead, an idea that some have used to justify taking organs without asking. Finally, I argue that opt-out systems cannot truly secure consent. Ultimately, the paper finds that opt-out deceased organ donation is unethical: if we want to give rights their due consideration, we must look to other methods of increasing organ supply.


Paper title: Opt-out paradigms for deceased organ donation are ethically incoherent

Author: G M Qurashi

Affiliations: Green Templeton College, University of Oxford, Oxford, UK

Competing interests: None

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