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Organ Donation: Opt In and Opt Out Strategies

  1. Ben Saunders

Published Online: 17 DEC 2012

DOI: 10.1002/9780470015902.a0024197



How to Cite

Saunders, B. 2012. Organ Donation: Opt In and Opt Out Strategies. eLS. .

Author Information

  1. University of Stirling, Stirling, UK

Publication History

  1. Published Online: 17 DEC 2012


Opt-in strategies only take organs from those who have specifically consented to donation, whereas opt-out strategies treat everyone as a willing donor unless they exempt themselves. Both strategies allow individuals (or their next of kin) power to determine what happens to their cadaveric organs; the difference between them is the ‘default’ treatment of someone who has expressed no wish either way. Opt-out strategies are likely to increase donation rates, because those who do not register a preference either way will be treated as donors. Opt-out strategies are often called ‘presumed consent’ and critics contend that this is unjustifiable. In fact, numerous other justifications for such a policy are available, for instance it may be that those who do not opt out thereby tacitly consent to the use of their organs.

Key Concepts:

  • Opt-in donation strategies means no one's organs are used without their consent.

  • Opt-out donation strategies mean that everyone is treated as a donor unless they specifically refuse.

  • Few countries operate ‘pure’ opt-in or opt-out strategies, because consent is usually sought from next of kin.

  • It is difficult to measure or predict the effects of a change in policy, but likely that an opt-out strategy will procure more organs than an opt-in strategy.

  • An opt-out strategy should not be identified with ‘presumed consent’.

  • There are a variety of possible justifications for an opt-out strategy, including tacit consent and normative consent.

  • ‘Tacit consent’ means that one's consent is implied by one's silence.

  • Tacit consent does not necessarily meet the conditions of informed consent.


  • bioethics;
  • consent;
  • opt in or opt out;
  • organ donation;
  • organ procurement;
  • organ transplant;
  • presumed consent;
  • tacit consent