• Donation/procurement of organs/tissues
• informed consent
• paternalism
• political philosophy
• public health ethics

There is much to agree with in Ben Saunders' article.1 He is right to say that presumed consent is only one, shaky, justification for opt-out organ retrieval. I believe he is also right that the value of altruism is of relatively little importance in morally assessing organ procurement schemes.2 But I am not so sure about his opt-out proposal.

Saunders would, I think, describe his proposal as an improvement on the existing system in that it would increase the supply of organs while still securing adequate consent. (I should add that he does not, however, explicitly claim that the supply would increase.) This description invites two questions: (1) would the consent be adequate? and (2) would the supply of organs increase? Before saying a few things in answer to these questions, I want to make what I think is the most important point in trying to sort through all the tangled debate about opt-in and opt-out systems: the UK system, in common with nearly all other ‘opt-in’ systems, does not require the consent of the …