Changes to English Law on Organ Donation: FAQs
What has changed?
As of May 2020, the English legislation with respect to organ and tissue donation changed from what is often referred to as an ‘Opt-in’ system to an ‘Opt-out’ system or ‘Deemed Consent’. In other words, whereas previously the law only permitted organ and tissue donation in cases where it could be established that this was the express decision of the donor or where the family consented, since May 2020 adults in England will be considered to have no objection to Organ and Tissue donation unless they have indicated that they do not want to donate (either via the NHS Organ Donor Register or having made this clear to family/ friends). People who lack mental capacity, prisoners, members of the armed forces and anyone not ordinarily resident in England are also excluded from deemed consent and the family will be approached for consent instead.
Does this mean that my organs can be taken against my wishes or those of my family?
No. It is absolutely clear that no person’s organs or tissue can be taken against their wishes at any time and consultation with a person’s family remains an essential part of the organ donation process. This means that if, for example, a person had shared their decision with their family/friends but not formally registered them on the NHS Organ Donor Register (ODR), that decision would still be respected.
This is one of the reasons why it is necessary to discuss the issue of organ and tissue donation with family and friends so that they are aware of your decision.
It should also be noted that donation will not proceed, in the very rare circumstances, whereupon relatives cannot be found to discuss the decision and the health and lifestyle of the potential donor. These details provide vitally important information in establishing compatibility for donation.
How does this impact me?
The change in English legislation has important implications for those in the Jewish community who would wish any decision about donating organs to be made in accordance with appropriate Halachic (religious legal) advice. It is therefore now more important than ever to take the time to understand the new system and to think about what you would like to happen if you were ever to be in a position to donate your organs.
Over recent years, the Office of the Chief Rabbi has worked closely with NHS Blood and Transplant (NHSBT) and the Human Tissue Authority to deliver an essential accommodation within the opt-out system which will allow a person to declare on the Organ Donor Register that their decision for donation is subject to their family receiving guidance from their chosen religious authority. This is explained in more detail below.
Does Jewish Law (Halacha) permit organ donation?
It is a common misconception that organ and tissue donation is never permitted according to Halacha. In fact, there is a very rich and complex body of Jewish Law which covers this important issue. Whilst it is certainly true that there are circumstances in which donation is not possible, there are nevertheless also circumstances in which it can be done with remarkable life-saving implications. The speed of advances in medical science also mean that in the future it may become easier for organ donation to take place in accordance with Halacha.
There are a range of Halachic opinions on the precise circumstances in which organ donation is permissible and each person should seek more detailed guidance from their own Rabbi.
What provision has NHS Blood and Transplant (NHSBT) made for the Jewish community?
NHSBT has created a provision which allows people to stipulate that their faith is important to them on the Organ Donor Register. The effect of this provision, where it is utilised, will be that wherever an opportunity arises for donation by an observant Jewish person, their family will be prompted by specially trained nursing staff to take account of their wishes in various ways, including by consulting with the person’s Rabbi before any donation can take place, as well as involving them throughout the donation process. A dedicated hotline now exists which is known only to the nurses involved in organ donation, and which can be accessed by family and NHS staff to obtain Halachic advice and direction. In that way, the new system allows observant Jews to engage positively with it, safe in the knowledge that their faith will be respected and their wishes carefully adhered to. The full text of the commitment made by NHSBT to those who make clear that their faith is important to them is available here.
What action do I need to take?
First, visit organdonation.nhs.uk and select the option to ‘register your decision’. If there are no circumstances in which you ever wish to donate organs, you can select the option to ‘opt out’ here and enter your name and contact details.
If however you would be willing to donate your organs but only in accordance with the guidance of your chosen religious authority, then select the option to ‘register to donate’ and enter your name and contact details.
Where you are asked whether you would be willing to donate ‘all’ or ‘some’ of your organs and tissue, you may select the option for ‘all’. This does not mean that you will actually donate all of your organs. The decision as to which organs, if any, can be donated in a Halachically compliant manner will be determined at the time by your religious authority together with your family.
In the faith/belief section, you will be presented with the following statement: ‘I would like the NHS staff to speak to my family and anyone appropriate about how organ donation can go ahead in line with my faith or beliefs.’ Select the option confirming that this statement applies to you.
Finally, enter your ethnicity, select ‘Jewish’ from the list of religions, and confirm your decision by selecting ‘submit’. Please note that the record of your Jewish faith, indeed of any person’s selected faith, is stored separately from your name and personal details on NHSBT records. The specialist nurses will be able to see that you had ticked the faith declaration but will not know your faith until they raise it with your family. They will find out about your faith by discussing this with your family along with the contents of your faith declaration and the mirrored commitment from NHSBT. They will support your family in speaking to a Rabbinical advisor if the family indicates that they wish to do so.
Once you have completed the registration process, you will be presented with the option to share your wishes with your family. Whether you choose to use this facility or you would prefer to discuss this with them in person, it is important to ensure that your family are aware of your wishes at the earliest available opportunity so that they are best able to respect them at what may be a difficult time.
Please also note that there is no deadline for registering one’s preferences. You can opt in or out of donation at any time and change your mind at any point. The specialist nurses will be able to see your recorded decision and confirm this with your family. It is therefore important to let your family know if you change your mind about donation.
What would I be agreeing to?
The commitment being made by those who agree to donate their organs in accordance with their religious beliefs, is set out in a detailed personal statement, the full text of which is available here. This personal statement sets out the various safeguards which are in place, including consultation with and support for your family and adherence with rabbinic guidance. The statement makes clear that donation can only proceed if your family and Rabbi are assured that donation can take place in line with Halacha.