How the Opt-Out System Works Across the UK

The UK has shifted to an opt-out organ donation system, sometimes called ‘deemed consent’ or ‘presumed consent.’ Under this system, all eligible adults are automatically considered potential organ donors unless they explicitly register a decision not to donate.

This marks a significant change from the previous opt-in approach, where individuals needed to actively register their consent. The change aims to increase the number of available organs for life-saving transplants while still respecting individual choice.

The transition to an opt-out system happened at different times across the UK nations:

• Wales led the way in December 2015
• England followed in May 2020 (under legislation known as ‘Max and Keira’s Law’)
• Scotland implemented its system in March 2021
• Northern Ireland was the most recent, adopting the approach in June 2023 (through ‘Dáithí’s Law’)

The Crown Dependencies have also moved toward opt-out systems, with Jersey implementing in July 2019 and Guernsey in January 2023. The Isle of Man has passed legislation but hasn’t yet implemented the opt-out system.

2. Who Is Excluded from Deemed Consent

Not everyone falls under the opt-out system. Specific groups excluded from deemed consent include:

• Children under 18 (or under 16 in Scotland)
• People who lack the mental capacity to understand the opt-out arrangements for a significant period before death
• Visitors to the UK
• People who have lived in the relevant nation for less than 12 months before their death

For these excluded groups, the traditional opt-in approach still applies, requiring explicit consent for organ donation.

How to Check and Update Your Organ Donation Status

1. Official Ways to Opt Out

If you decide you don’t want to be an organ donor, you need to register this decision officially. There are several ways to opt out of organ donation in the UK:

Online Registration: The most direct method is through the NHS Organ Donation website (organdonation.nhs.uk). Go to the ‘Register your decision’ section and select ‘Do not donate.’ This ensures your decision is recorded in the central database.

By Phone: Call the NHS Organ Donation line at 0300 123 2323. The line is open 24 hours a day, 7 days a week, and operators can register your opt-out decision immediately.

NHS App: If you have the NHS App installed on your smartphone, you can update your organ donation preferences through the ‘Your health’ section. Look for ‘Organ donation’ under ‘Your health choices.’

Paper Form: You can also request a paper form by calling the NHS Organ Donation line if you prefer not to use digital methods.

A critical distinction exists between ‘opting out’ and ‘withdrawing’ your registration that many people misunderstand:

Opting Out: This means actively registering a decision NOT to donate your organs. Your preference is recorded on the NHS Organ Donor Register as a clear ‘no.’

Withdrawing: This simply removes any previously recorded decision from the register without recording a new one. If you only withdraw without registering a new decision, you’ll automatically fall under the deemed consent (opt-out) system, meaning you’re considered a potential donor by default.

To ensure you’re not considered for organ donation, you must explicitly register a decision not to donate, not just withdraw a previous registration.

3. Verifying Your Current Registration Status

1. Visit the NHS Organ Donation website
2. Select ‘Check or update your recorded decision’
3. Enter your personal details to view your current status
4. Alternatively, call 0300 123 2323 to verify your status

Key Agencies Holding Your Organ Donation Status

1. NHS Organ Donor Register: The Authoritative Source

The NHS Organ Donor Register is the central, authoritative database for all organ donation decisions in the UK. Healthcare professionals check this register first to assess organ donation status.

This register contains:

• Your personal details
• Your donation decision (yes, no, or no recorded decision)
• Which organs and tissues you’re willing to donate (if applicable)
• Date your decision was registered

Notably, while this is the primary source, other agencies may hold separate records of donation preferences that don’t automatically sync with the NHS Organ Donor Register.

2. Driver and Vehicle Licensing Agency (DVLA)

The DVLA has a long-standing partnership with NHS Blood and Transplant, accounting for approximately 12.6 million registrations on the NHS Organ Donor Register. When you apply for or renew your driving license, you’re asked about organ donation preferences.

If you’ve registered as a donor through the DVLA, your license will display code ‘115’ next to code ’12’ in the bottom left corner on the back. This code shows you’re registered as an organ donor.

Importantly, if you opt out through the NHS Organ Donor Register after initially registering as a donor through the DVLA, your driving license won’t automatically update to remove code 115. You’ll need to contact the DVLA separately to update your license.

3. HM Passport Office

The HM Passport Office has a partnership with NHS Blood and Transplant allowing passport applicants to register their organ donation decisions. This recent initiative provides another entry point to the NHS Organ Donor Register.

When applying for or renewing a passport, you may be asked about your organ donation preferences. Similar to the DVLA partnership, this information is shared with the NHS Organ Donor Register, but updates to your preferences made via the NHS won’t automatically appear in your passport application records.

4. NHS App and Healthcare Records

The NHS App has become an increasingly popular way to manage health preferences, including organ donation decisions. Over half a million people have registered organ donation decisions through the app.

The app provides a convenient way to:

• Check your current organ donation status
• Register a new decision
• Update your preferences
• Specify which organs and tissues you would or wouldn’t want to donate

While healthcare providers may have notes about your organ donation preferences in your medical records, the NHS Organ Donor Register remains the definitive source that will be consulted.

Fixing Your DVLA Organ Donation Status

1. How to Identify Code 115 on Your License

Checking whether you’re registered as an organ donor with the DVLA is straightforward. Look at the back of your driving license at the bottom left corner. You’ll always see code ’12’ (indicating that the license relates to a car or motorcycle). If you also see code ‘115’ next to it, this confirms you’re registered as an organ donor with the DVLA.

This code may appear even if you’ve previously opted out through the NHS Organ Donor Register, as these systems don’t automatically synchronise. Many people find this code on their license when they thought they had already opted out of organ donation.

2. Step-by-Step Process to Remove Donor Status

If you find code 115 on your license and want it removed, follow these steps:

1. Contact the DVLA by calling 0300 790 6801
2. Provide your details including full name, address, date of birth, and driving license number
3. Explain your request – state clearly that you wish to have the organ donor status (code 115) removed from your license
4. Request instructions for sending your license back for updating
5. Return your license with a cover letter explaining your request to remove the organ donor status
6. Wait for your updated license to arrive (typically within 3 weeks and at no cost)

There is no fee for this update, and the DVLA will issue a new license without the organ donor code.

3. Confirming the Update Was Completed

Once you receive your new driving license, immediately check the back to ensure code 115 has been removed. If it’s still present, contact the DVLA again and explain that the update wasn’t processed correctly.

Keep any correspondence with the DVLA about this request, including a copy of your cover letter and any reference numbers provided during the process. This documentation can be useful if there are any issues with the update.

Updating Your Passport Organ Donation Status

1. Identifying Your Passport Donor Classification

Unlike driving licenses, UK passports don’t display a visible code indicating your organ donor status. However, the HM Passport Office does collect organ donation preferences during the application and renewal process.

If you provided organ donation information when applying for or renewing your passport, this would have been shared with the NHS Organ Donor Register. There’s no way to visually confirm this status on your passport itself.

2. Options For Removing Donor Status

Since your passport doesn’t display your donor status, you don’t need to update the passport itself. Instead, focus on updating the NHS Organ Donor Register directly:

1. Register your decision not to donate on the NHS Organ Donor Register through their website or phone line
2. When you next renew your passport, ensure you don’t select the option to register as an organ donor

Documenting Your Decision Beyond Official Registers

1. Informing Your Family of Your Wishes

Regardless of official registrations, healthcare professionals will always consult your family before proceeding with organ donation. This conversation happens even if you’ve registered as a donor or are subject to deemed consent.

It’s important to have clear conversations with close family members about your decision to opt out of organ donation to ensure they are fully aware.

2. Rapid Response Advance Decision Notice and Medical ID Options

An Advance Decision Notice (sometimes called a Living Will) allows you to specify your preferences for medical interventions, including organ donation. This personal declaration of your wishes takes precedence over any other national records.

An Advance Decision Notice within ‘My Medical Choice’s’ Medical Legal Protection System provides first responders with rapid access to your most up-to-date medical legal directives in an emergency.

Various options exist for signalling your preferences, including My Medical Choice ID cards, medical alert wearables and QR codes.