Table 2

Additional key terms and operational definitions

Key termDefinition
Opt-in organ donation systemThe default is to be a non-donor unless an individual actively registers or expresses to be an organ donor
Opt-out organ donation systemThe default is presumed consent (called deemed consent in Wales) to organ donation, unless an individual actively opts-out
Hard opt-out organ donation systemThe family are not consulted
Soft opt-out organ donation systemThe family are consulted
Soft opt-out eligibility criteria WalesOver 18 years, voluntarily resident in Wales, mental capacity, die in Wales
Expressed decisionA person may register their decision on the organ donor register or convey it verbally or in writing to family members (see table 1 for options available under the different systems)
Organ donor registerUnder the former opt-in system individuals could only opt-in to be a donor on the register. With the introduction of the soft opt-out system in Wales the register was amended so that individuals can opt-in or opt-out of organ donation on the register, and appoint a representative to convey the decision for them
Presumed/deemed consentThe terms are interchangeable, but in Wales the term used is deemed consent. A person* who has not actively expressed their organ donation decision during life is considered to have no objection to organ donation and their consent can be deemed
Known donation decisionThe potential organ donor has made their decision known during their life-time by either registering it on the organ donation register or conveying it verbally or in writing to family members/close friends
Family consent in the soft opt-out systemFamily consent is for children under 18 years, and for potential organ donors who do not meet residency criteria or lack mental capacity
Organ donation decision overridesUnder the new soft opt-out system, family members are expected to support the organ donation decision of their relative made in life. To override their relative’s decision family members should provide witnessed written evidence or a witnessed conversation that the potential organ donor had changed their mind and opted for a different donation decision (the last known decision)
  • *Eligibility criteria apply.