Outside of the United States

United Kingdom

The United Kingdom operates under a model of expressed consent.  The Human Tissue Act of 2004 states that if a person has, while alive and competent, given consent for some or all of their organs or tissue to be donated following his or her death (by joining the NHS Organ Donor Register or by other means) then that consent is sufficient for the donation.

The NHS Organ Donor Register is a national, confidential list of people who are willing to become donors after their death. It can be quickly accessed to see whether an individual has registered a willingness to be an organ donor. Millions of people carry donor cards or are on the register.  Since 2002, around a million people joined the NHS ODR every year

Learn more about Organ Donation in the UK.

Register with the NHS Organ Donor Register OR by calling 0300 123 23 23


A mobile app has been developed in Switzerland to help address the nationwide organ shortage. The new e-organ donor card function allows donor information to automatically display on the home screen of smartphones brought into the emergency room, even if the screen is locked.

In 2012, Swisstransplant partnered with Facebook, which allowed users to state on their timelines that they supported donation. Swiss donors were able to follow a link from Facebook to order a donor card from Swisstransplant.

Learn more about Organ Donation in Switzerland.


Until recently, Israel ranked at the bottom of Western countries on organ donation.  However, there is now a special incentive to donate organs.  Israel decided to try a new system that would give transplant priority to as a recipient to patients who are designated as donors.  In doing so, it became the first country in the world to incorporate “non-medical” criteria into the priority system, though medical necessity would still be the first priority.

The new law, passed in 2010, states that people who are prepared to sign donor cards themselves receive priority when they are in need of an organ transplant. Increased priority is given to first degree relatives of those who have signed donor cards, to first degree relatives of those who have died and donated organs, and to living kidney, liver lobe or lung lobe donors who donated for as yet undesignated recipients.  The consent rate from families and the number of organs available for patients has already increased.

The National Transplant Center of Israel is the sole organization in Israel in which registration for transplant is done and by means of which allocation of the organs for transplant takes place.  Each organ transplant carried out in Israel requires an individual authorization of the National Transplant Center-Ministry of Health.

Learn more about Organ Donation in Israel.

Register with the National Transplant Center of Israel.


In Belgium, if an individual does not want to donate, he or she is required to register the objection with the Central Health Authority.  Prospective donors can change their decisions at any time.  While physicians are under no obligation to ask the prospective donor’s family for permission to recover the organs, or even to inform them of the intention to do so, if a family member explicitly oppose organ recovery, the physician cannot proceed.  Consent is presumed for Belgian citizens as well as anyone who has lived in the country for 6 months or more.  Less than 2% of the Belgian population has registered an objection to organ donation.


Spain is considered the gold standard in organ donation because it has maintained the highest organ donation rate of any other country in the world, with 35.3 organ donors per million people. (Compared to 26 organ donors per million in the United States)

Unlike the United States, which has an opt-in policy, Spain has an opt-out policy, meaning citizens are automatically organ donors unless they opt out.

Spain still asks families whether they want to donate their loved ones’ organs before they are recovered. As such there is not true presumed consent program.

A lot has to do with educating the public on how organ donation works, especially if its new to the culture.

Read more about Organ Donation in Spain.

Other Countries with Presumed Consent

Other countries that have “opt-out” systems/”presumed consent” laws include Austria, France, Columbia, Norway, Italy, and Singapore.  In Austria, the rate of donation quadrupled within 8 years of its presumed-consent policy being introduced.  Today, the procurement rate in Austria is twice as high as those in the United States and most of Europe.

Specifically, in France, the Caillavet Law of France allows a third party to state whether the potential donor had objections, even if the donor him/herself had not registered as a donor.  In Norway, organs may be removed after the relatives have been informed of the intention to remove them, and only the immediate next-of-kin can halt procurement by withholding consent.

In Italy, despite presumed consent laws, organs may only be removed once it has been determined that the donor’s relatives do not object.  While in Singapore, all residents receive a letter when they reach the age of 18 that states they are presumed to consent to organ donation unless they explicitly object to it.

Learn more about Presumed Consent vs. Express Consent Laws.