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What is the opt out system?

This page provides answers to some of the most common questions about the upcoming changes to the law around organ donation in England.

If you would like to speak to somebody about changes in the law, please call our dedicated line: 0300 303 2094

What is changing?

The law around organ donation is changing in England. This means that from spring 2020, all adults in England will be considered an organ donor when they die unless they had recorded a decision not to donate or are in one of the excluded groups.

This is commonly referred to as an ‘opt out’ system.

You can record your decision to opt in or out on the Organ Donor Register.

Those excluded will be people under 18, people who have lived in England for less than 12 months or who are not living here voluntarily, and people who lack the capacity to understand the change.

Adults covered by the change will still have a choice whether they want to be an organ donor and which organs they would like to donate, and their families will still be involved before organ donation goes ahead. 

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Why do we need an opt out system?

There has been tremendous progress in organ donation but there is still a shortage of donors. Last year, 411 patients died in the UK on the transplant waiting list.

To continue our progress, we need a transformation in public attitudes. More than 6 out of 10 families agree to organ donation but to meet the needs of patients we need at least 8 out of 10 families to support donation and agree to save and improve lives.

The latest evidence from Wales suggests that consent rates have increased significantly since they introduced the opt out system in 2015. The government is keen to see the same progress in England.

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When will the opt out system start?

The ‘opt out system’ will come into in spring 2020.  The exact date of when the new system will be implemented has not yet been confirmed by Government.

Legislation to change the law around organ donation in England has passed through the Parliamentary process and received Royal Assent

The changes will not come into effect immediately to make sure there is plenty of time to inform people about what is changing. This will give people time to choose if they want to be an organ donor and to share this decision with their family and friends.

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Will you automatically take my organs if I don't opt out?

No. Organ donation can only happen in a small number of cases. Around 500,000 people die every year in the UK, but only around 1 in 100 of them die in circumstances where they are able to donate their organs. Organs can only be transplanted very soon after someone has died and they need to be in a usable condition. Donors can usually only be people who have died in a hospital intensive care unit or accident and emergency department. Because of these constraints, every potential donor is precious.

Your family will be approached before donation takes place so it is really important that you choose whether you want to be a donor and let them know. Discuss your decision with your family so they can help ensure your choice is honoured.

Your faith and beliefs will also always be taken into consideration before organ donation goes ahead. 

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Am I losing control of what happens to my body?

No. It will still be for you to choose if you want to be an organ donor. And if you don’t want to donate, it’s really quick and simple to record your decision on the NHS Organ Donor Register. The quickest and easiest way to do this is online. If you don’t have internet access, you can also call our contact centre on 0300 123 23 23.

You can update your preferences on the NHS Organ Donor Register quickly and easily at any time. We will not take people’s organs without permission.

Your family will always be consulted before donation takes place. It is important that your family and friends know your choice. This makes it easier for them to honour your choice, whatever that choice is.

Your faith and beliefs will also always be taken into consideration before organ donation goes ahead. 

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Will you still ask my family's permission?

Yes. Families will continue to be consulted before organ donation goes ahead. There are a number of reasons for this:

  • Out of consideration to the family who are facing the loss of someone close to them;
  • The family may have important information about the person’s decision around donation that is more recent than any decision recorded on the NHS Organ Donor Register;
  • Family support helps ensure important information about their relative, such as their medical, travel and social history is available to our specialist nurses in organ donation. The information that families provide before organ donation goes ahead, together with medical notes and other tests, is vital to understanding whether the person’s organs are safe to transplant into somebody else.

Your family will always be approached if organ or tissue donation is a possibility. If you have already made a decision about donation and shared this with your family, they would be expected to support your decision, whatever that is.

If you have not recorded a decision either way and you are not in an excluded group, your family will be approached and asked if they have any information about your organ donation decision. If no information is available, it will be considered that you consent to donate your organs and your family would be expected to support this.

People under the age of 18 and those lacking mental capacity are excluded from the new law, but may still record a decision on the NHS Organ Donor Register. This information will be made available to the family at the time of the discussion. The final decision for organ donation from people in excluded groups is made by the family, but they will be encouraged by the specialist nurse to take any recorded decision into account.

Do these changes affect my children?

The opt out system does not apply to children under the age of 18 years old. In circumstances where a donation decision is required for someone under 18, the family will be asked to make that decision and provide consent.

The NHS Organ Donor Register is open to everyone, regardless of age. If a child wants to register their decision, or the parent of a child wants to do that for them, this option is available. The information recorded on the NHS Organ Donor Register is accessible to the specialist nurses in organ donation who approach the family about the possibility of organ donation.

Will my funeral plans be affected?

The surgery carried out to remove a donor’s organs is carried out by highly skilled professionals, with the same care, attention and respect as they would in any operation to save a patient’s life. The surgical incisions are carefully dressed after the surgery and any end of life care wishes in relation to the washing and dressing of the body are respected.

Many donors go on to have an open casket funeral.

What happens if I do nothing?

Once the new system comes into effect in England, if you have not expressed your decision to opt out of donation and are not in an excluded group, it will be considered that you consent to donate your organs. So even if you don’t record that you want to be an organ donor, it is important to let your family know what you want.

If you have specific instructions about which organs you would or would not like to donate, you should provide this information when you record your donation decision on the NHS Organ Donation Register

If you die in circumstances where donation is possible, your family will always be asked if some or all of your organs should be donated. Your organs will not be donated without their consent.

If you’ve already registered a decision to donate your organs on the NHS Organ Donor Register, and have not yet told your family, please let them know.

If you have recorded an opt out decision on the Organ Donor Register, then you should make sure your family know what you have decided.

If you want to update or reaffirm your decision, you can complete the Amend your details form or call 0300 123 23 23.

Can I change my mind?

Yes. If you have recorded an organ donation decision on the NHS Organ Donor Register and want to update your details, or change or reaffirm your decision, you can complete the Amend your details form or call 0300 123 23 23.

It is important to share your decision to be an organ donor with your family. This will give them more confidence that they know that you wanted to donate and make it easier for them to honour your decision.

More of your questions answered

About the change

About your decision

Already registered?

Your family's role

Your faith and beliefs



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