TY - JOUR T1 - Organ donation: opting in or opting out? JF - British Journal of General Practice JO - Br J Gen Pract SP - 62 LP - 63 DO - 10.3399/bjgp18X694445 VL - 68 IS - 667 AU - Chris J Rudge Y1 - 2018/02/01 UR - http://bjgp.org/content/68/667/62.abstract N2 - Both Jeremy Corbyn and Theresa May have recently expressed their support for a change to the law in England to introduce an opting-out system for organ donation, and the Department of Health is consulting on the issue. This is based on the assumption that it would make a significant impact on the shortage of organs for transplantation and thus save hundreds of lives each year. It is a popular assumption, because the intention is so obviously well meaning. Sadly, though, it is an assumption that offers false hope.There is no good evidence from anywhere in the world that a change in the law leads to a sustained increase in donation. Indeed, there are countries where in fact donation has decreased, and Brazil offers perhaps the best example of this. The few publications that suggest a possible benefit have important methodological flaws that make it very difficult to isolate the impact of the law.1 The evidence was reviewed in great detail as part of the second Organ Donation Taskforce report in 2008,2 and little has changed since then. So what is the basis for the assumption? There are at least two important misunderstandings in the case that are often made. First, there is the superficially attractive observation of the Spanish donation experience. Spain has opting-out legislation and for many years has had the highest donation rate in the world. But the Spanish authorities have stated repeatedly that their ‘success’ does not stem from the law.3 Opting out was introduced in Spain in 1979, with no apparent effect. Ten years later, in 1989, a national … ER -