Organ donation and consent

Sir, – The Government intends to change the system of identifying potential organ donors to a model where individuals are presumed to be donors unless they have previously expressly chosen not to be so. This is subject to the family of the deceased not objecting, a so-called soft opt-out model. "Soft" consent is the norm internationally. The central question that has to be answered is, does it work? Does it increase the number of transplants? In answering this, it is essential not to engage in ad hoc argument. Invocations to "Look at Spain" (which has a particularly effective system of organ donation) are likely to be met by "Ireland is not Spain". A better approach is to look at peer-reviewed studies of organ donation in many countries.

The three most recent that I know of are by Abadie & Gay (2006), Healy (2005) and Johnson & Goldstein (2003). All three look at a pool of western, mostly European, countries over time.

Details differ but a clear general pattern that emerges is that presumed consent is associated with higher levels of cadaveric organ donation, even controlling for factors such as religion, GDP, legal systems and transplantation infrastructure. The first of these studies found, for example, that organ donations are 25-30 per cent higher in presumed-consent countries.

An important result that also emerges is that one of the most important sources of cadaveric organs for transplantation are road deaths. In Ireland, road deaths have been steadily declining for decades – the last 15 years have seen a fall in road deaths of 55 per cent. As a proportion of the population, this is a staggering 64 per cent fall. While this is good news in itself, it points to a significant continuing decline in the supply of organs for donation.


At the end of 2012, there were 563 people awaiting kidney and pancreas transplants. Given the shortages, many will wait a significant amount of time, on average 30 months, with a consequent reduced quality of life. In 2012, 14 people on this waiting list died.

Finally, while there is a strong argument in favour of presumed consent, it is certainly not a magic bullet. It is essential to invest in the necessary infrastructure, including in human resources. Otherwise the proposed policy will be a missed opportunity. – Yours, etc,


School of Economics,

Geary Institute,

University College Dublin,

Belfield, Dublin 4.