{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T10:10:18Z","timestamp":1790503818578,"version":"4.1.0"},"reference-count":40,"publisher":"BMJ","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Ethics"],"published-print":{"date-parts":[[2003,6]]},"abstract":"<jats:p>In the wake of scandals about the unauthorised retention of organs following postmortem examination, the issue of valid consent (or the lack of it) has returned to the forefront. Emphasis is put on obtaining explicit authorisation from the patient or family prior to any medical intervention, including those involving the dead. Although the controversies in the UK arose from the retention of human material for education or research rather than therapy, concern has been expressed that public mistrust could also adversely affect organ donation for transplantation. At the same time, however, the British Medical Association (BMA) continues to call for a shift to a system of presumed consent for organ transplantation. This apparent inconsistency can be justified because valid distinctions exist between the reasons requiring explicit consent for retention and the acceptability of presumed consent for transplantation. This paper argues for introducing a system of presumed consent for organ donation, given the overwhelming expressions of public support for transplantation. Ongoing legislative review in the UK provides an ideal chance to alter the default position to one where potential donors can simply acquiesce or opt out of donation. Combined with consultation with their relatives, this could be a much better method of realising individuals\u2019 wishes. It would also achieve a better balance between the duties owed to the deceased and those owed to people awaiting a transplant.<\/jats:p>","DOI":"10.1136\/jme.29.3.147","type":"journal-article","created":{"date-parts":[[2003,6,9]],"date-time":"2003-06-09T23:09:42Z","timestamp":1055200182000},"page":"147-152","source":"Crossref","is-referenced-by-count":36,"title":["Presumed consent for transplantation: a dead issue after Alder Hey?"],"prefix":"10.1136","volume":"29","author":[{"given":"V","family":"English","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Sommerville","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2003,6,1]]},"reference":[{"key":"2024052910421090000_29.3.147.1","unstructured":"Redfern M. The Royal Liverpool Children\u00e2\u0080\u0099s Inquiry Report. London: The Stationery Office, 2001."},{"key":"2024052910421090000_29.3.147.2","unstructured":"Department of Health & Welsh Assembly Government. Human bodies, human choices: the law on human organs and tissue in England and Wales, a consultation report. London: Department of Health, 2002."},{"key":"2024052910421090000_29.3.147.3","unstructured":"Written answer: organ donor register. House of Commons official report (Hansard) 2002 June 13, vol 1386, no 158: col 1445W."},{"key":"2024052910421090000_29.3.147.4","unstructured":"Price D. Legal and ethical aspects of organ transplantation. Cambridge: Cambridge University Press, 2002: 2."},{"key":"2024052910421090000_29.3.147.5","unstructured":"The Human Tissue Act 1961 provided for inquiries to be made about whether the deceased or the relatives had any objection to the retention of organs and tissue but it was unclear about how rigorous such inquiries had to be and what information had to be given to relatives. There was no proper definition of what human material was covered by the act and no effective sanctions for breaching it."},{"key":"2024052910421090000_29.3.147.6","unstructured":"Department of Health. Report of a census of organs and tissues retained by pathology services in England. London, The Stationery Office, 2001."},{"key":"2024052910421090000_29.3.147.7","unstructured":"Department of Health, Department for Education and Employment and Home Office. The removal, retention and use of human organs and tissue from postmortem examination. London: The Stationery Office, 2001: 38."},{"key":"2024052910421090000_29.3.147.8","unstructured":"See reference 2: 2."},{"key":"2024052910421090000_29.3.147.9","unstructured":"In July 2000, an Omnibus survey of 2000 people carried out on behalf of the National Kidney Research Fund found that 57% of those questioned would support a system of presumed consent. In February 2001, a telephone poll conducted by the BBC\u00e2\u0080\u0099s Watchdog Healthcheck attracted nearly 52 000 callers of whom 78% supported a shift to presumed consent. A survey of MPs carried out in March 2001 by the National Kidney Research Fund found that 59% of the 163 MPs who completed the questionnaire supported a shift to presumed consent."},{"key":"2024052910421090000_29.3.147.10","unstructured":"See reference 1: 408."},{"key":"2024052910421090000_29.3.147.11","unstructured":"The Bristol Royal Infirmary Inquiry. The inquiry into the management of care of children receiving complex heart surgery at the Bristol Royal Infirmary. Interim report. Removal and retention of human material part IV. London: Central Office of Information, 2001: 49."},{"key":"2024052910421090000_29.3.147.12","unstructured":"See reference 1: 360."},{"key":"2024052910421090000_29.3.147.13","unstructured":"See reference 1: 400."},{"key":"2024052910421090000_29.3.147.14","unstructured":"New B, Solomon M, Dingwall R, et al. A question of give and take. Improving the supply of donor organs for transplantation. London: King\u00e2\u0080\u0099s Fund Institute, 1994: 61."},{"key":"2024052910421090000_29.3.147.15","unstructured":"Department of Health. Organ and tissue transplantation: a plan for the future\u00e2\u0080\u0094consultation document. London: Department of Health, 2001."},{"key":"2024052910421090000_29.3.147.16","unstructured":"UK Transplant. More transplants\u00e2\u0080\u0094new lives. Business case to the Department of Health, England and the Health Departments in Scotland, Wales, and Northern Ireland 2001\u00e2\u0080\u00932005. Bristol: UK Transplant, 2001."},{"key":"2024052910421090000_29.3.147.17","unstructured":"UK Transplant. Transplant update\u00e2\u0080\u0094June 2002. Bristol: UK Transplant, 2002."},{"key":"2024052910421090000_29.3.147.18","unstructured":"UK Transplant. Number of cadaveric donors and transplants in the UK, 1992\u00e2\u0080\u00932001 and patients on the active and suspended waiting lists at 31 December. Bristol: UK Transplant, 2002."},{"key":"2024052910421090000_29.3.147.19","unstructured":"UK Transplant. Organ donation and transplant activity per million population (pmp) in Europe, 2001. Bristol: UK Transplant, 2002."},{"key":"2024052910421090000_29.3.147.20","unstructured":"See reference 14: 61."},{"key":"2024052910421090000_29.3.147.21","unstructured":"NHS Executive. Identification of potential donors of organs for transplantation. 1994 Oct 10: HSG(94)41."},{"key":"2024052910421090000_29.3.147.22","unstructured":"British Medical Association. Organ donation in the 21st century. Time for a consolidated approach. London: British Medical Association, 2000."},{"key":"2024052910421090000_29.3.147.23","unstructured":"National Museum of Photography, Film and Television, Bradford. Conference proceedings: organ donation & transplantation\u00e2\u0080\u0094the multifaith perspective. Bradford: The Bradford Hospitals NHS Trust, 2001."},{"key":"2024052910421090000_29.3.147.24","unstructured":"See reference 23: 13 and 17."},{"key":"2024052910421090000_29.3.147.25","doi-asserted-by":"crossref","unstructured":"Youngner S. Psychosocial and ethical implications of organ retrieval.N Engl J Med 1985;313:321\u00e2\u0080\u00934 at 323.","DOI":"10.1056\/NEJM198508013130510"},{"key":"2024052910421090000_29.3.147.26","unstructured":"See reference 4: 1."},{"key":"2024052910421090000_29.3.147.27","unstructured":"Harris J. Clones, genes and immortality. Oxford: Oxford University Press, 1998: ch 5."},{"key":"2024052910421090000_29.3.147.28","unstructured":"For a good discussion of different laws on organ donation see reference 4."},{"key":"2024052910421090000_29.3.147.29","unstructured":"Human Tissue Act 1961 for England, Scotland, and Wales and Human Tissue Act (Northern Ireland) 1962 for Northern Ireland."},{"key":"2024052910421090000_29.3.147.30","unstructured":"Provided individuals have a genuine opportunity to opt out of donation, it is difficult to envisage any breach of people\u00e2\u0080\u0099s legal rights including those conferred by the Human Rights Act."},{"key":"2024052910421090000_29.3.147.31","doi-asserted-by":"publisher","DOI":"10.1136\/jme.25.5.365"},{"key":"2024052910421090000_29.3.147.32","unstructured":"Two studies undertaken in Spain found that 30% of families that refused consent would have changed their minds one year later. These studies were quoted in: Council of Europe. Meeting the organ shortage. Current status and strategies for improvement of organ donation. Strasbourg: Council of Europe, 1999."},{"key":"2024052910421090000_29.3.147.33","unstructured":"British Medical Association. Human genetics: choice and responsibility. Oxford: Oxford University Press, 1998: 11\u00e2\u0080\u009326."},{"key":"2024052910421090000_29.3.147.34","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1136\/bmj.1.5218.61","volume":"1","year":"1961","journal-title":"BMJ"},{"key":"2024052910421090000_29.3.147.35","first-page":"53","volume":"XV11","year":"1995","journal-title":"Transplantation Proceedings"},{"key":"2024052910421090000_29.3.147.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)08212-3"},{"key":"2024052910421090000_29.3.147.37","unstructured":"This drop was also undoubtedly due in part to debate about the definition of death. See Rix B. Brain death, ethics, and politics in Denmark. In: Youngner SJ, Arnold RM, Schapiro R, eds. The definition of death. Contemporary controversies. Baltimore: Johns Hopkins University Press, 1999:227\u00e2\u0080\u009338."},{"key":"2024052910421090000_29.3.147.38","unstructured":"Michielsen P. Informed or presumed consent legislative models. In: Chapman JR, Deierhoi M, Wight C, eds. Organ and tissue donation for transplantation. London: Arnold, 1997: 344\u00e2\u0080\u009360."},{"key":"2024052910421090000_29.3.147.39","doi-asserted-by":"publisher","DOI":"10.1136\/jme.5.1.13"},{"key":"2024052910421090000_29.3.147.40","unstructured":"See reference 14: 62."}],"container-title":["Journal of Medical Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jme.29.3.147","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,29]],"date-time":"2024-05-29T17:42:27Z","timestamp":1717004547000},"score":1,"resource":{"primary":{"URL":"https:\/\/jme.bmj.com\/lookup\/doi\/10.1136\/jme.29.3.147"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,6]]},"references-count":40,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2003,6,1]]},"published-print":{"date-parts":[[2003,6]]}},"alternative-id":["10.1136\/jme.29.3.147"],"URL":"https:\/\/doi.org\/10.1136\/jme.29.3.147","relation":{},"ISSN":["0306-6800","1473-4257"],"issn-type":[{"value":"0306-6800","type":"print"},{"value":"1473-4257","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,6]]}}}