When Can Others Help Themselves to Our Organs?

July 25, 2019 • Posted in Blog


D. Joy Riley, M.D., M.A.
Executive Director

We have an opt-in organ donation system in the United States. That is, you have to say, “Yes,” to organ donation in order to donate. Opting in is very easy, and you can usually do that through your local Department of Motor Vehicles (DMV). Even those too young to vote can opt-in for organ donation. Why is this service available through the DMV? A few moments’ thought can yield an answer.

England has recently changed its law governing organ donation. The new “opt-out” law takes effect in 2020:

Everyone in England over the age of 18 will be considered to be in favour of donating their organs and tissues after death unless:

  • they have said they don’t want to donate their organs (they have “opted out”)
  • they have appointed a representative to decide for them after their death
  • they are in one of the excluded groups – under the age of 18, ordinarily resident in England for less than 12 months before their death, or lack mental capacity for a significant period before their death

Harvesting of organs and tissues for “routine” transplantation includes abdominal wall muscles and rectus sheath, blood vessels (arteries and veins), bone, eye, heart, heart valves, intestine, kidney, liver, lung, muscle, “nervous tissue,” pancreas, skin, spleen, stomach, and tendon. These tissues and organs are currently on the list, and, beginning in 2020, may be procured upon death from citizens aged 18 and older, unless excepted (as quoted above). One other exception is if any of these tissues, cells, or genes will be “manipulated in a laboratory for treatment of a disease or injury.” In the case of such Advanced Therapy Medicinal Products (ATMP), explicit permission will be needed.

The new law was written because, while many British citizens said they supported organ donation, there were significantly fewer who signed on to donate. With 5,000+ on the organ recipient waiting list, and three deaths per day amongst those waiting, Parliament decided to act. Before the law comes into effect, however, the government is conducting another consultation to clarify potentially more organ and tissue availability. After all, organ transplantation is an evolving field. It may be desirable in the future to use other organs or tissues. For now, the government wants to know, should express permission be necessary for these “donations”?

The government is planning to exclude the following parts of the body. This means you or someone representing you would need to give explicit permission for them to be donated:

  • brain
  • spinal cord
  • face
  • nose
  • mouth
  • trachea (windpipe)
  • arm
  • upper arm
  • forearm
  • hand
  • finger
  • leg
  • thigh
  • lower leg
  • foot
  • toe
  • ovary
  • uterus
  • penis
  • testicle
  • foetus
  • placenta
  • umbilical cord
  • embryo (inside the body)
  • limbal stem cells (eye cells that allow the cornea to regenerate) – if they are used for an ATMP
  • liver cells – if they are used for an ATMP
  • pancreatic cells – if they are used for an ATMP

Is this the right list? The British government wanted to know. The consultation concluded on 22 July. The Tennessee Center for Bioethics & Culture was invited (via email) to reply to the consultation. Here is part of our response:

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Another issue needs to be considered in thinking about the process of organ procurement in England. The language used includes “donation.” Yet, no one actually has to give their organs or tissues, at least in the cases of “routine” transplantation in an opt-out system. The tissues and organs are procured by force of law. Procuring by force or authority is also known as coercion.

On the other hand, in the United States, does attending a class at school or signing a DMV form constitute informed consent?

Informed consent is shorthand for informed, voluntary, and decisionally-capacitated consent. Consent is considered fully informed when a capacitated (or “competent”) patient or research participant to whom full disclosures have been made and who understands fully all that has been disclosed consents voluntarily to treatment or participation on this basis.


Food for thought for citizens on “both sides of the pond.”


Generous Gift from Local Multimedia Artist, Carol Harkness, Benefits TN-CBC

unnamed (1)Flourishing, an original mixed media mosaic on birchwood (11.5″ X 11.5″) in a hand-rubbed walnut frame, has benefitted The Tennessee Center for Bioethics & Culture in a tangible way. In agreement with Artist Carol Harkness, we offered this beautiful work of art (value, $450) as a prize for the largest donation received by our organization during the month of June, 2019.

We received $2,070 in donations during June, with the largest gift being $1,100. The “winning” donors prefer to remain anonymous, and have donated Flourishing back to The Tennessee Center for Bioethics & Culture: Generosity has beget generosity. Thank you to all who participated!

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