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Opt-out organ donation without presumptions
  1. Ben Saunders
  1. Correspondence to Ben Saunders, Room A82, University of Stirling, Stirling FK9 4LA, Scotland, UK; ben.saunders{at}


This paper defends an ‘opt-out’ scheme for organ procurement, by distinguishing this system from ‘presumed consent’ (which the author regards as an erroneous justification of it). It, first, stresses the moral importance of increasing the supply of organs and argues that making donation easier need not conflict with altruism. It then goes on to explore one way that donation can be increased, namely by adopting an opt-out system, in which cadaveric organs are used unless the deceased (or their family) registered an objection. Such policies are often labelled ‘presumed consent’, but it is argued that critics are right to be sceptical of this idea—consent is shown to be an action, rather than a mental attitude, and thus not something that can be presumed. Either someone has consented or they have not, whatever their attitude to the use of their organs. Thankfully, an opt-out scheme need not rest on the presumption of consent. Actual consent can be given implicitly, by one's actions, so it is argued that the failure to register an objection (given certain background conditions) should itself be taken as sign of consent. Therefore, it is permissible to use the organs of someone who did not opt out, because they have—by their silence—actually consented.

  • Allocation of health care resources
  • consent
  • donation/procurement of organs/tissues
  • embryos and fetuses
  • enhancement
  • genetic screening/testing
  • government/criminal justice
  • informed consent
  • medical ethics
  • organ donation
  • philosophical ethics
  • presumed consent

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  • Funding Funding for this work was received from the University of Stirling.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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