ArticleTransplant international : official journal of the European Society for Organ Transplantation2026
Five years after introduction of an opt-out consent system for organ donation; lessons learned from England and the Netherlands.
Article in Transplant international : official journal of the European Society for Organ Transplantation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Five years after changing from opt-in to opt-out consent systems in England and the Netherlands, we examine the impact on donor registrations, consent rates, donor numbers, and reflect on lessons learned. Opt-out legislation was implemented in May 2020 in England and July 2020 in the Netherlands. In England, 44% of the population is now registered; 40% recording an opt-in decision and 4% an opt-out decision. In the Netherlands, mandated donor registration resulted in the entire adult population having their decision recorded: "Yes, I want to be a donor" (34%), "No objection" (24%), or "No, I don't want to be a donor" (31%), while 11% leave the "Decision to next of kin". Despite these structural changes, the consent categories created by opt-out legislation ("deemed" consent in England and "No objection" in the Netherlands) remain challenging in practice, with fewer than 50% of families agreeing to donation. In England, the family consent rate declined from 69% to 57% between 2020 and 2025 and the donor numbers remain below pre-pandemic levels. In contrast, the Netherlands experienced a modest increase in family consent rates and donor numbers compared to the opt-in consent system. Opt-out legislation provides an important policy framework, but sustained system-level commitment remains essential.
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