Absence of significant dissent should be sufficient for deceased donor organ procurement in New Zealand


  • Thomas M. Douglas,

    1. Oxford Uehiro Centre for Practical Ethics, Oxford University, United Kingdom
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  • Nicholas M. Douglas

    1. Menzies School of Health Research, Darwin, Australia and Centre for Clinical Vaccinology and Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, United Kingdom
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Correspondence to:
Dr Thomas Douglas, Oxford Uehiro Centre for Practical Ethics, Suite 8, Littlegate House, St Ebbes St, Oxford OX1 1PT, United Kingdom. Fax: +44 (0) 1865 286886; e-mail: thomas.douglas@philosophy.ox.ac.uk


Objective: New Zealand's organ donation rates are among the lowest in the OECD. In a bid to increase organ availability, the New Zealand Human Tissue Act 2008 introduces new consent arrangements for deceased donor organ procurement. This article assesses these new arrangements and presents the case for further reform.

Approach: Our assessment and arguments are based on philosophical analysis informed by empirical data on the effectiveness of alternative consent systems. We: 1) Identify widely held ethical judgments about policies and practices relevant to organ donation (e.g. those relating to coronial post-mortems), 2) Assess the implications of these judgments for the Human Tissue Act and the assumptions that underpin it, and 3) Derive policy recommendations that are consistent with the judgments.

Conclusion: The Human Tissue Act 2008 retains a strong consent requirement for organ procurement: organs may not be transplanted unless either the deceased or the family consents. We argue that organ availability could and should be increased by shifting from a model that requires consent to one that requires the absence of significant dissent.

Implications: We recommend that New Zealand adopt either 1) an organ donation system similar to the existing system for ordering coronial post-mortems, or 2) a variant of the ‘opt-out’ system already in place in several other countries.