Presumed Consent or Opt-Out: What does it mean?

You may have come across the term ‘presumed consent’ or ‘opt out’ in conversations about organ and tissue donation policies around the world. Countries like the United Kingdom have adopted this approach, where individuals are considered potential donors unless they explicitly opt out. In contrast, the United States follows an opt-in, first-person authorization system. This means individuals must actively register their decision to become organ, eye, and tissue donors. Once the decision is legally documented, typically through a state registry or driver’s license, no further approval is needed at the time of death.

The Opt-in System is Preferred and Works for Americans

A presumed consent system may seem like a logical way to address the organ shortage, but before supporting it, consider these key facts about how it works and why it may not be the best fit for the United States.

No Systems Operate as True Presumed Consent Models

While presumed consent has been enacted in several Western European countries, in practice, most of these systems are implemented as family authorization, with families effectively able to override the presumption of consent.

Presumed Consent Removes the Opportunity for Discussion with the Family

With the current opt-in system, organ procurement organizations can talk directly with the families of potential donors. This gives families a chance to ask questions and make informed decisions. Switching to an opt-out system would take away that important opportunity for family conversations about donation.

Understanding Public Attitudes Toward Presumed Consent

The most recent national study on presumed consent was commissioned by the Department of Health and Human Services in 2019. It found that 34% of people would choose to opt out if the U.S. adopted a presumed consent system. This data offers important insight into how many Americans feel about organ donation policies.

Many people view presumed consent as a decision imposed by the government rather than a personal choice. This perception could lead some to opt out, not because they oppose organ donation, but because they do not want to be automatically enrolled.

The latest global research from the Max Planck Institute in 2024 also found that switching to an opt-out system does not increase organ donation rates. Their study of five countries showed no significant rise in donations after adopting presumed consent policies.

Presumed Consent is Not in Alignment with American Legal Principles

Laws in the U.S. focus strongly on individual rights and freedoms. Presumed consent may conflict with these principles. While it might seem promising, such a big change could impact public trust in organ donation. Still, ongoing conversations about it are important.

Opt-out or Presumed Consent Would Not Make More Organs Available for Transplant

Finally, data suggests moving to an opt-out system would not make more organs available for transplant in the U.S. Under our current opt-in system, 48,149 organ transplants were performed in 2024, according to data from the Organ Procurement and Transplantation Network (OPTN). That was made possible by the generous contributions of 16,988 deceased donors and 7,030 living donors in the United States. These numbers show the U.S. opt-in system works well. People have to voluntarily decide to register, but many do, which leads to relatively high donation rates.