References

Ahmad MU, Hanna A, Mohamed AZ A systematic review of opt-out versus opt-in consent on deceased organ donation and transplantation (2006-2016). World J Surg. 2019; 43:(12)3161-3171 https://doi.org/10.1007/s00268-019-05118-4

Bennett C. What is this thing called ethics?.New York, NY: Routledge; 2015

Bhopal A. Building a culture of organ donation. BMJ. 2019; 365 https://doi.org/10.1136/bmj.l1636

British Medical Association. Organ donation. 2021. https://tinyurl.com/j5yfampm (accessed 18 October 2021)

Dalal AR. Philosophy of organ donation: review of ethical facets. World J Transplant. 2015; 5:(2)44-51 https://doi.org/10.5500/wjt.v5.i2.44

Department of Health and Social Care. Opt-out organ donation: Max and Keira's Bill passed into law. 2019. https://tinyurl.com/yka8585a (accessed 18 October 2021)

Gandjour A, Lauterbach KW. Utilitarian theories reconsidered: common misconceptions, more recent developments, and health policy implications. Health Care Anal. 2003; 11:(3)229-244 https://doi.org/10.1023/B:HCAN.0000005495.81342.30

Human Tissue Authority. Donation of solid organs and tissue for transplantation. Part two: deceased organ and tissue donation. 2020. https://tinyurl.com/kfekfkjz (accessed 18 October 2021)

International Registry in Organ Donation and Transplantation. Preliminary Numbers 2018. 2019. https://tinyurl.com/pvtnemrz (accessed 18 October 2021)

Kim JR, Fisher MJ, Elliott D. Attitudes of intensive care nurses towards brain death and organ transplantation: instrument development and testing. J Adv Nurs. 2006; 53:(5)571-582 https://doi.org/10.1111/j.1365-2648.2006.03759.x

Mental Health Foundation. Mental capacity. 2021. https://tinyurl.com/6aj97f2m (accessed 18 October 2021)

Miller J, Currie S, O'Carroll RE. ‘If I donate my organs it's a gift, if you take them it's theft’: a qualitative study of planned donor decisions under opt-out legislation. BMC Public Health. 2019; 19:(1) https://doi.org/10.1186/s12889-019-7774-1

NHS Blood and Transplant. Organ donation law in England is changing. 2021. https://tinyurl.com/4nctsjt6 (accessed 18 October 2021)

Prabhu PK. Is presumed consent an ethically acceptable way of obtaining organs for transplant?. J Intensive Care Soc. 2019; 20:(2)92-97 https://doi.org/10.1177/1751143718777171

Royal College of Nursing. End of life care: the nursing role. 2019. https://www.rcn.org.uk/clinical-topics/end-of-life-care/the-nursing-role (accessed 20 October 2021)

Savulescu J, Persson I, Wilkinson D. Utilitarianism and the pandemic. Bioethics. 2020; 34:(6)620-632 https://doi.org/10.1111/bioe.12771

Shepherd L, O'Carroll RE. When do next-of-kin opt-in? Anticipated regret, affective attitudes and donating deceased family member's organs. J Health Psychol. 2014; 19:(12)1508-1517 https://doi.org/10.1177/1359105313493814

Sque M. Researching the bereaved: an investigator's experience. Nurs Ethics. 2000; 7:(1)23-34 https://doi.org/10.1177/096973300000700105

Applying utilitarianism to the presumed consent system for organ donation to consider the moral pros and cons

28 October 2021
Volume 30 · Issue 19

Abstract

In May 2020, England adopted an opt-out approach for organ donation, also referred to as the deemed consent system, with the aim of alleviating the demand for organs in the UK. This system dictates that those who have not opted out will have their organs donated following their death, with the exception of those meeting certain criteria. This article applies the philosophical theory of utilitarianism to the deemed consent system for organ donation, focusing particularly on topics such as that of informed consent and family refusal. Utilitarianism is a consequentialist theory that attempts to determine whether an action is morally right or wrong based on whether or not it maximises the preferences of the greatest number of people, with each person's satisfaction being considered as equal to another's.

In March 2019, the Organ Donation (Deemed Consent) Bill received Royal Assent and became an Act of Parliament. Named Max and Keira's Law after the girl who donated and the boy who received a heart, the act introduces an opt-out system for organ donation in England (Department of Health and Social Care (DHSC), 2019). In Wales, such legislation has been in effect since 2015, while in Scotland it will come into effect in 2021; it is currently under consideration by the Northern Ireland Assembly.

The opt-out system (also commonly referred to as presumed consent or deemed consent) refers to a process whereby all people will be presumed to have given consent to donate their organs after death. This excludes those who are under the age of 18 years, are not British citizens, have lived in England for a period shorter than 1 year, have registered their wish to not donate their organs (including those who have registered this wish informally with family members), or do not have the capacity to understand the changes to the system (DHSC, 2019; British Medical Association (BMA), 2021). Furthermore, the idea that this is a ‘soft’ opt-out system ensures that the consent of the family is still required for the donation to proceed, as per the Human Tissue Authority (2020) codes of practice.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content