Introduction: Opt-out legislation, known in the UK as deemed consent/authorisation, was implemented in Wales (2015), England (2020), Scotland (2021) and Northern Ireland (2023). While legislation wording varies slightly between UK nations, the core principle is that adults who have not opted out, and who are not in excluded group (defined in the legislation but relating to residency and mental capacity) are considered to have agreed to organ donation after death. The impact of this legislation is regularly evaluated by NHS Blood and Transplant and publicly available¹.
Method: The NHS Organ Donor Register (ODR) allows individuals across the UK to record a decision to opt-in or opt-out of organ donation. The UK Potential Donor Audit audits deaths in UK Intensive Care Units (ICUs) and Emergency Departments, excluding patients aged over 80 years. Paediatric ICU data are included however neonatal ICU data was excluded.
Results: Currently, 41.6% of the UK population have opted-in on the ODR (England 39.6%, Wales 43.9%, Scotland 53.7% and Northern Ireland 56.3%). A further 3.9% of the UK population have opted-out (England 4.0%, Wales 5.8%, Scotland 3.4% and Northern Ireland 1.3%).
Over the past 5 years the overall consent/authorisation rate in the UK has declined from 69.3% to 58.8%. Of the four UK nations, Scotland has the highest consent/authorisation rate at 63.1% and Wales the lowest 57.2%. All nations of the UK have seen a decline in consent/authorisation.
In the most recent year the deemed consent/authorisation rate was 48.2% (England 46.3%, Wales 55.1%, Scotland 63.0% and Northern Ireland 47.8%). This contrasts with individuals who have opted-in on the ODR where the consent/authorisation rate was 85.7% (England 85.9%, Wales 86.7%, Scotland 85.4% and Northern Ireland 80.6%). Where neither opt-in or deemed was appliable the consent/authorisation rate was 37.7%.
Funnel plot statistical analysis reveals there is no statistical difference between all four nations of the UK in consent/authorisation overall, though owing to population differences, England dominates the funnel plot.

Conclusion: Over the last five years, despite all nations of the UK having opt-out legislation, the consent/authorisation rate last year has declined to 58.8% and the deemed/consent authorisation rate was 48.2%.
NHS Blood and Transplant is leading a deep exploration into its promotion and clinical processes to try to maximise benefits from the legislation change.

References
1. www.odt.nhs.uk/statistics-and-reports/opt-out-legislation-reports/