Explained: What does the new organ donation legislation mean?

Kenneth Fox

With the news that legislation meaning everyone in Ireland will become organ donors when they die unless they opt out, it is fair to ask what exactly it will mean for Irish citizens?

The HSE welcomed the Human Tissue Act 2024 Part 2, saying it provides a national legislative framework for organ donation and transplant services in Ireland for the first time.

But how will the new laws work and how exactly do you opt out? Here is everything you need to know about the legislation:

What does the new legislation mean?

Under the new legislation, all adults in Ireland will be considered to have agreed to be an organ donor when they die, unless they have recorded a decision not to donate on the National Organ Donation Opt-Out Register or are in one of the excluded groups.

This is commonly referred to as a soft opt-out organ donation system

The HSE said family members will always be consulted before any action is taken and if they do not agree, then the donation will not proceed.

Those who do not wish to donate their organs, for whatever reason, and have recorded their objection on the new National Organ Donation Opt-Out Register will have their wishes respected, and their family will not be approached on the issue of organ donation.

The Act also provides a framework for living donation and will, for the first time, provide a way for people who wish to donate a kidney to someone they do not personally know, the opportunity to do so. This is known as non-directed altruistic donation. They are donating an organ for someone on a waiting list who needs it.

Who can opt-out from organ donation?

The opt out system will not apply to children under the age of 18 years old. Parents and guardians must give their consent to donate their child’s organs in instances where this is possible.

There are some exceptions included in the Act where deemed consent will not apply. These include:

• People who do not normally live in Ireland or who have lived here for less than a year;
• People who may not have had the capacity to make a decision to opt out of organ donation before they died;
• People whose family members cannot be contacted in time to confirm that they do not object to the donation of their loved one’s organs;
• Deemed consent, or the soft opt out system of consent, only applies to relevant organs as defined in the Act which are: heart, lungs, liver, pancreas and kidneys;
• If a person adds their name to the opt out register, they will not be considered for donation of any of these organs. It is not possible to opt out of donation of individual relevant organs. For all other organs, tissues, or cells, consent will be sought from the family member – as was previously the case;
• The Act provides for non-directed altruistic donation by adults only, with additional protections and safeguards in place for those wishing to donate;
• An Independent Panel will be established which will consider, among other types of donations, applications for non-directed altruistic donations. The legislation does not allow anyone to pressure a living donor. It also prohibits any payment or reward for donating organs, tissues, or cells.

What other countries have similar laws?

The UK and several other EU countries such as Austria, Belgium, Croatia, Germany, Hungary, Luxembourg, The Netherlands and Slovenia have similar legislation.

Each of these countries have presumed consent in which citizens must place their name on a national opt-out register, otherwise their consent for donating their organs will be presumed.

Speaking on the register, Dr Colm Henry, chief commercial officer, HSE said; “The opt-out organ donation system will bring us in line with international best practice. Organ transplantation is one of the great advances in modern medicine."

How many people are waiting for organ donations in Ireland?

According to the HSE, at any given time approximately 600 people in Ireland are on waiting lists for organ transplants.

Dr Henry said: "It offers a second chance at life to people with life-threatening illnesses or injuries to their vital organs. Every year, more than 200 people in Ireland have their lives improved or saved by the gift of organ donation.

“I encourage you to have a conversation with your family or next of kin and let them know your wishes around organ donation.”

“When someone dies, their family must agree to donate their organs. It is important to inform your family and friends about your decision regarding organ donation, as they will always be consulted and your wishes should be central to any decision.

“The Act sets out who is considered a “designated family member” and this is usually the family member who has been the main point of contact for clinicians in their treatment of the deceased.

"This is the person who has to provide consent to the organ donation. If no consent is received or no designated family member is found then the donation will not proceed," he said.

Where can I find out more information?

The HSE is running an information campaign to inform the public of the changes around organ donation and how to access the opt-out register. For more information you can go here.