What is the opt out system in England?

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 changes 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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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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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. Due to these constraints, every potential donor is precious.

Find out more about the organs you can donate

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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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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.

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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 would be accessible to the specialist nurses in organ donation who approach the family about the possibility of organ donation.

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The surgery carried out to remove a donor’s organs is carried out by highly skilled professionals who take the same care and attention, and offer the same 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.

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You can choose at any time whether to opt in or out of becoming an organ and tissue donor. You can:

Register to be a donor - Sign up as an organ donor, and choose which organs and tissue to donate.

Register not to be a donor - Opt out of all organ and tissue donation.

Change or amend  - Update your details or preferences from a previous registration.

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.

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It is common for laws to be named after campaigners in recognition of their efforts to bring important issues to the public attention.

The organ donation system in England has changed to increase donation and help more patients get the transplants they so desperately need. It is fantastic that the government has so publicly recognised that without donors there can’t be transplants.

The government publicly announced that the legislation would be commonly referred to as Max’s Law, in recognition of all the campaigning Max Johnson and his family were doing when Max was waiting for a heart transplant and have continued to do since receiving the heart he so desperately needed.

Max’s gift of life came from a young girl called Keira Ball, who tragically passed away aged 9 years old. Her parents made the selfless decision to help others through their own tragedy.

• Read Max's organ donation story in full here

The new opt out legislation does not apply to those under the age of 18. 

• 'Read more about Max and Keira's Law'.

No. There are certain groups of people who are not included in the law:

• People under the age of 18
• People who lack mental capacity to understand the new arrangements and take the necessary action
• People who have lived in England for less than 12 months or who are not living here voluntarily

Anyone can sign up to be a donor at any age. But if someone dies under the age of 18 in England, their parents would still be asked to consent on their child’s behalf before organ donation can go ahead. If there was a decision recorded on the NHS Organ Donor Register, this information would be shared with the family.

This law 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.

Find out more about the law change for those under the age of 18

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

If you want to donate, the best way to make sure your decision is honoured is to register as a donor and tell your family. The NHS Organ Donor Register will be accessed by a specialist nurse prior to a conversation with your family to check if any donation decision has been recorded.

Telling your family you want to donate and carrying an organ donor card are equally valid forms of consent, but sometimes cards are not available at such a critical time. We would always advocate that you register your decision on the NHS Organ Donor Register and share this decision with your family.

Once the new system comes into effect in England, if you have not expressed your decision to opt out of organ 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 a decision that you want to be an organ donor, you should let your family know what you want.

If you opt out, you will be recording that you do not want to donate any of your organs or tissue, and opting out of donation completely.

If you are willing to be a donor but want to specify which organs and/or tissue you would like to donate, you should register as a donor on the NHS Organ Donor Register.

This information would then be available to the specialist nurse in organ donation who looks up your record on the NHS Organ Donor Register. They will discuss what you had consented to donate with your family.  

Any organs or tissue not selected by you would not be considered for donation unless the family raise anything to the contrary. An example may be that a family may believe that their relative hadn’t selected their heart because they had previously had a heart attack. The specialist nurse may discuss what the donor’s thought process may have been in not selecting the heart for donation. In this scenario, the heart wouldn’t be considered for heart donation as a solid organ but may still be considered for heart valves depending on the information provided by the family.  

At the moment in the UK, there is a limb transplant programme, but face and uterus transplant programmes have not yet been introduced.

The current organ donation system does not cover rare or novel transplants such as limb, face or uterus donation. A person’s family would have to give explicit permission before their loved one’s limb, face or uterus could be donated.

It is the government’s intention to maintain the status quo for novel transplants, so express consent is required for donation of that organ or tissue to go ahead.

It has always been the government’s intention that the opt out system will only include routine transplants.

No. You should only opt out if you do not want to be a donor. There are many medical conditions that will mean a particular organ cannot be used in transplantation but others could be used to save lives. The decision about whether your organs can be safely used to help others is established at the time of your death.

Your full medical history will be taken from your family, medical notes and GP notes, and your family also provide information about your travel and social history. This information is used by transplant surgeons to decide which organs can be safely donated and transplanted.

If you prefer not to have your wishes recorded on the NHS Organ Donor Register you must tell your family your donation wishes and ask them to honour them on your behalf. 

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

Yes. The ability to register an opt out decision has been available to all UK residents since July 2015, in preparation for the Welsh law change in December 2015.

If you don't want to make an organ donation decision yourself, or if you have specific instructions, and you live in England, Wales or Northern Ireland you can appoint up to two people to make that decision for you. If you die in circumstances where donation is possible, your appointed representative(s) will be asked if your organs should be donated.

The appointed / nominated representative(s) registration process requires physical signatures from the individual concerned, the appointed representative(s) and a witness. To add appointed / nominated representatives to the NHS Organ Donor Register, you will need to identify those representatives and they will need to sign the form in the presence of a witness.

• Nominate a representative

Once NHS Blood and Transplant receives your completed form, your information and the details of your appointed representatives will be added to the NHS Organ Donor Register and this information will be available to our specialist nurses if you are identified as a potential donor.  

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

If you have previously registered as an organ donor and want to update your details or reaffirm your decision, you can complete the 'amend your details' form online. 

Alternatively, you can amend your details by phoning 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.

You can change your decision by completing the online form to 'amend your details'.

Your new registration record will be matched with your old one and updated.

If you live in England, Wales or Northern Ireland you can appoint up to two people to make the final decision about organ donation for you. If you die in circumstances where donation is possible, your appointed representative(s) will be asked if your organs should be donated.

To add appointed representatives to the NHS Organ Donor Register, you will need to ask them to sign the online 'nominate a representative' form in the presence of a witness.

Once NHS Blood and Transplant receives this form, your information and the details of your appointed representatives will be added to the NHS Organ Donor Register and this information will be available to our specialist nurses if you are identified as a potential donor.

If you do not have internet access you can call our contact centre on 0300 123 23 23, and one of our team will arrange to send the form by post.

If organ donation is a possibility, medical staff will do everything they can to find family members. If no family members are available, a friend of long standing can be consulted.

The Human Tissue Authority (HTA) have set out Codes of Practice, which include a list of those who should be approached about organ donation. This starts with your family, then includes friends and care workers who will have known you and may be able to speak for you.

The NHS has a duty to consider the safety of any organs for transplant. This is why speaking to the family, or someone else appropriate, about medical and lifestyle history is so important.

If you do not have family to support your decision, you can nominate a representative who will be asked if your organs should be donated.

If you have no family or friends available, organ donation may still go ahead if your decision to donate your organs is registered on the NHS Organ Donor Register.

If you have no family or friends available, have not registered a decision to donate your organs and a deemed consent or ‘opt out’ system applies where you live; organ donation will not go ahead.

If you have no family or friends available and have registered a decision not to donate your organs, this decision will be honoured.  

Yes. NHS Blood and Transplant specialist nurses have always explored an individual’s faith and / or beliefs with families as a matter of routine.

In December 2018, NHS Blood and Transplant introduced a new feature on the NHS Organ Donor Register to provide reassurance to people that their religious, faith or belief-based concerns would be honoured during donation.

The NHS Organ Donor Register now includes the option to record if you would like specialist nurses to speak to your family about your faith or beliefs. The nurses will have this information available to them before they speak to their family.

• Get more information about the faith declaration on the NHS Organ Donor Register
• Get more information about faith, beliefs and organ donation

Our specialist nurses will always do what they can to involve faith representatives if a family requests this. Faith representatives can help the family and support the donation process going ahead in line with the individual’s beliefs.

• Get more information about faith, beliefs and organ donation

Answers to frequently asked questions about changes to organ donation law in England are available to download in:

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