RT Journal Article SR Electronic T1 Opt-out donation and tacit consent: a reply to Wilkinson and De Wispelaere JF Journal of Medical Ethics JO J Med Ethics FD BMJ Publishing Group Ltd and Institute of Medical Ethics SP 75 OP 76 DO 10.1136/medethics-2011-100349 VO 38 IS 2 A1 Ben Saunders YR 2012 UL http://jme.bmj.com/content/38/2/75.abstract AB In this reply to Wilkinson and De Wispelaere, I argue that an opt-out donation system can be regarded as tacit consent. I first separate the opt-in/opt-out issue from that of the role that the family ought to play. I then argue that what De Wispelaere calls minimal approval-tracking is not obviously necessary and that, even if it were, opt-out schemes can satisfy this requirement.