Organ Donation Law in Wales.

Wales operates a soft opt-out system for organ and tissue donation. The system, known legally as deemed consent, came into force on 1 December 2015 under the Human Transplantation (Wales) Act 2013. This means that some adults who die in Wales may be treated as having no objection to organ donation unless they have recorded a decision to opt out or fall within an excluded group. Everyone still has a choice. You can:

• Register a decision to donate;
• Register a decision not to donate; or
• Take no action, in which case consent may be deemed if the legal conditions are satisfied.

When Can Consent Be Deemed?

Deemed consent may generally apply where a person:

• Was aged 18 or over;
• Had lived voluntarily in Wales for at least 12 months immediately before death;
• Died in Wales;
• Had the mental capacity to understand the organ donation arrangements;
• Had not registered a decision to opt out; and
• Had not otherwise clearly expressed an objection to donation.

The system does not mean that every person who dies in Wales automatically becomes an organ donor. Donation is possible only in particular medical circumstances, and specialist teams must assess whether organs or tissue are suitable.

Who Is Excluded?

Deemed consent will not normally apply to:

• Children under 18;
• People who had not lived voluntarily in Wales for at least 12 months;
• People who lacked capacity for a significant period before death to understand the effect of the law;
• People who died outside Wales; or
• People who recorded or clearly expressed a decision not to donate.

People who are temporarily living in Wales, including many visitors and short-term residents, are therefore not generally covered by deemed consent.

Registering Your Decision

You can record a decision to donate all or selected organs and tissue, or register a decision not to donate, on the NHS Organ Donor Register. A registered decision can be changed or withdrawn at any time. Recording a decision is preferable to relying solely on deemed consent because it provides clearer evidence of your intentions.

The Role of the Family

Organ donation is not carried out without discussion with the family or another person who was close to the deceased. Specialist nurses will normally:

• Check the NHS Organ Donor Register;
• Explain the donation process;
• Discuss the deceased person's known wishes;
• Ask whether the deceased expressed any objection that was not formally registered;
• Consider religious, cultural and personal information; and
• Support the family throughout the process.

The family is not simply asked to decide on behalf of the deceased. The purpose of the discussion is to establish and honour the deceased person's own decision. However, organ donation teams will take into account the information and concerns provided by the family. In practice, donation may not proceed where the family strongly objects or provides credible evidence that the deceased would not have agreed.

Can a Family Override a Registered Decision?

A person's recorded decision to donate should be respected. Nevertheless, medical teams will always speak to the family before proceeding. A family may have information showing that the deceased changed their mind, had relevant beliefs or expressed an objection after registering. Where there is no such evidence, relatives should not treat the decision as their own to reverse. Discussing your wishes with those close to you reduces uncertainty and makes it more likely that your decision will be supported.

What Can Be Donated?

Depending on medical suitability and the circumstances of death, donation may include:

• Kidneys;
• Heart;
• Liver;
• Lungs;
• Pancreas;
• Small bowel;
• Corneas;
• Bone; and
• Other suitable tissue.

You can choose to donate all eligible organs and tissue or restrict your decision to particular donations. Some unusual or non-routine forms of transplantation are not covered by deemed consent and require express consent.

Religion and Personal Beliefs

The organ donation register allows people to record information about their faith or beliefs. Specialist nurses can involve an appropriate faith representative or adviser where requested. Many major faith groups support organ donation in principle, but views may differ between individuals and communities. Anyone with concerns should discuss them with a religious adviser and record a clear decision.

Donation Across the UK

Organs donated in Wales are allocated according to clinical need and national transplant arrangements. They may be transplanted into a patient elsewhere in the UK. Likewise, patients living in Wales may receive organs donated elsewhere in the UK. England, Scotland and Northern Ireland now also operate opt-out systems, although the legislation and terminology differ across the nations.

Why Talking to Your Family Matters

Registering your decision is important, but telling your family is equally valuable. At a time of sudden bereavement, relatives may be uncertain or distressed. Knowing what you want can make the discussion easier and help ensure that your decision is followed. You should tell those closest to you:

• Whether you wish to donate;
• Whether your decision applies to all or only selected organs and tissue;
• Whether religious or cultural wishes should be considered; and
• That your decision is recorded on the NHS Organ Donor Register.

Further Information

You can register, amend or withdraw an organ donation decision through the NHS Organ Donor Register. Further guidance about the Welsh system is available from the Welsh Government organ donation service.