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Max & Keira's Law

In this series of articles, our medical students will discuss a range of topics from medical ethics to the NHS to public health to medical conditions to clinical governance


On the 20th of May 2020, the organ donation in England moved move from a ‘opt in’ system to an ‘opt out’ system. This is following The Organ Donation Act passed on the 15th of March 2019. The time-lag between the Act being past and being put into force allowed the government’s public awareness campaign to raise awareness of the new system, giving people the time to have the conversations that they need. The Act is known as Max and Keira’s Law in honour of a 9 year old boy who received a heart transplant and the 9 year old girl who donated it.

The Act amends the Human Tissue Act 2004 in relation to ‘appropriate consent’ when a person dies;

‘Opt in’ = Organs can only be donated if the person themselves has actively given consent during their lifetime, or if the family gives consent after the person has died (only valid if the person had given no indication in their lifetime that they would not want to donate their organs).

‘Opt out’ = Adults in England will be considered potential donors unless they choose to opt out or are excluded (they can also opt out some or all organs). Relatives will still be asked for their opinion which can lead to donations being blocked if they object regardless of the wishes of the deceased.

People excluded from Max and Keira’s Law;

  • People under 18

  • People who lack the mental capacity to understand the changes to organ donation for a significant period before their death

  • People who have not lived in the UK for 12 months before their death or who was not living in England voluntarily

England changing to an ‘opt out’ system can help save thousands of lives each year. Every day around three people in need of an organ die because not enough organs are available for transplant.Currently 80% of people in England support organ donation but only 38% have opted in, leaving families with a difficult decision when their loved one dies. Less than half of families give consent for their loved one’s organs to be donated if they are unaware of their wishes. Max and Keira’s Law aims to help spread awareness of organ donation and prompt conversations between family members on this topic, to help them make decisions in the best interests of their loved ones. The change in law also better reflects what research shows most people want to happen after they die.

A soft ‘opt out’ system has proven to be successful in Wales. The Human Transplantation (Wales) Act 2013 came into effect in 2015 and has had excellent results for patients. Wales has a 80% consent rate to organ transplants, making it the highest consent rates in the UK compared to England's 67%. One organ donor can save or transform the lives of up to nine people.

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