{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T06:02:46Z","timestamp":1789452166905,"version":"build-2803163510"},"reference-count":14,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T00:00:00Z","timestamp":1789430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontierspartnerships.org"],"crossmark-restriction":true},"short-container-title":["Transpl. Int."],"abstract":"<jats:p>Five years after changing from opt-in to opt-out consent systems in England and the Netherlands, we examine the impact on donor registrations, consent rates, donor numbers, and reflect on lessons learned. Opt-out legislation was implemented in May 2020 in England and July 2020 in the Netherlands. In England, 44% of the population is now registered; 40% recording an opt-in decision and 4% an opt-out decision. In the Netherlands, mandated donor registration resulted in the entire adult population having their decision recorded: \u201cYes, I want to be a donor\u201d (34%), \u201cNo objection\u201d (24%), or \u201cNo, I don\u2019t want to be a donor\u201d (31%), while 11% leave the \u201cDecision to next of kin\u201d. Despite these structural changes, the consent categories created by opt-out legislation (\u201cdeemed\u201d consent in England and \u201cNo objection\u201d in the Netherlands) remain challenging in practice, with fewer than 50% of families agreeing to donation. In England, the family consent rate declined from 69% to 57% between 2020 and 2025 and the donor numbers remain below pre-pandemic levels. In contrast, the Netherlands experienced a modest increase in family consent rates and donor numbers compared to the opt-in consent system. Opt-out legislation provides an important policy framework, but sustained system-level commitment remains essential.<\/jats:p>","DOI":"10.3389\/ti.2026.16664","type":"journal-article","created":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:10:16Z","timestamp":1789449016000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Five years after introduction of an opt-out consent system for organ donation; lessons learned from England and the Netherlands"],"prefix":"10.3389","volume":"39","author":[{"given":"Nichon Esther","family":"Jansen","sequence":"first","affiliation":[{"name":"Research Department, Dutch Transplant Foundation","place":["Leiden, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tineke Jentina","family":"Wind","sequence":"additional","affiliation":[{"name":"Department of Organ Donation Coordination, Maastricht Universitair Medisch Centrum+","place":["Maastricht, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin B. A.","family":"Heemskerk","sequence":"additional","affiliation":[{"name":"Research Department, Dutch Transplant Foundation","place":["Leiden, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aline C.","family":"Hemke","sequence":"additional","affiliation":[{"name":"Research Department, Dutch Transplant Foundation","place":["Leiden, Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire","family":"Williment","sequence":"additional","affiliation":[{"name":"NHS Blood and Transplant Blood Donation","place":["Bristol, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Madden","sequence":"additional","affiliation":[{"name":"NHS Blood and Transplant Blood Donation","place":["Bristol, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dale","family":"Gardiner","sequence":"additional","affiliation":[{"name":"NHS Blood and Transplant Blood Donation","place":["Bristol, United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,15]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"lsab003","DOI":"10.1093\/jlb\/lsab003","article-title":"Deemed consent for organ donation: a comparison of the English and Scottish approaches","volume":"8","author":"Parsons","year":"2021","journal-title":"J L Biosciences"},{"key":"B2","unstructured":"Annual activity report 2024\/25. ODT clinical \u2013 NHS blood and transplant\n          \n          \n          2025"},{"key":"B3","doi-asserted-by":"publisher","first-page":"35","DOI":"10.3389\/ti.2022.10466","article-title":"Changing to an opt out system for organ donation-reflections from England and Netherlands","volume":"35","author":"Jansen","year":"2022","journal-title":"Transpl Int"},{"key":"B4","volume-title":"Office for National Statistics","year":"2026"},{"key":"B5","unstructured":"Cijfers\n          \n          Office for National Statistics\n          \n          2026"},{"key":"B6","unstructured":"Cijfers over organen en weefsels (Power BI dashboards)\n          \n          \n          2026"},{"key":"B7","volume-title":"Evaluation of the Organ Donation (Deemed Consent) Act, 2019 in England: Final Report","author":"McLaughlin","year":"2024"},{"key":"B8","doi-asserted-by":"publisher","first-page":"103816","DOI":"10.1016\/j.iccn.2024.103816","article-title":"Potential donor family behaviours, experiences and decisions following implementation of the organ donation (deemed consent) act 2019 in England: a qualitative study","volume":"86","author":"McLaughlin","year":"2025","journal-title":"Intensive Crit Care Nurs"},{"key":"B9","volume-title":"How Good or Bad Are National NHS Services?","year":"2026"},{"key":"B10","unstructured":"A bolder, braver approach for organ donation in the UK: final report of the organ donation joint working group\n          \n          \n          2025"},{"key":"B11","doi-asserted-by":"publisher","first-page":"1338","DOI":"10.1126\/science.1091721","article-title":"Medicine. Do defaults save lives?","volume":"302","author":"Johnson","year":"2003","journal-title":"Science"},{"key":"B12","doi-asserted-by":"publisher","first-page":"pgaf311","DOI":"10.1093\/pnasnexus\/pgaf311","article-title":"Crowding-out effects of opt-out defaults: evidence from organ donation policies","volume":"4","author":"G\u00fcnt\u00fcrk\u00fcn","year":"2025","journal-title":"PNAS Nexus"},{"key":"B13","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1186\/s13054-023-04581-9","article-title":"How clinicians discuss patients' donor registrations of consent and presumed consent in donor conversations in an opt-out system: a qualitative embedded multiple-cas44e study","volume":"27","author":"van Oosterhout","year":"2023","journal-title":"Crit Care"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e1713","DOI":"10.1097\/TXD.0000000000001713","article-title":"Nova Scotia's deemed consent for deceased organ donation: family member perspectives and experiences in the ICU setting","volume":"10","author":"Sarti","year":"2024","journal-title":"Transpl Direct"}],"container-title":["Transplant International"],"original-title":[],"link":[{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.16664\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T05:10:18Z","timestamp":1789449018000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontierspartnerships.org\/articles\/10.3389\/ti.2026.16664\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,15]]},"references-count":14,"alternative-id":["10.3389\/ti.2026.16664"],"URL":"https:\/\/doi.org\/10.3389\/ti.2026.16664","relation":{},"ISSN":["1432-2277"],"issn-type":[{"value":"1432-2277","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,15]]},"article-number":"16664"}}