England's Max and Keira's Law: A New Era for Organ Donation

Here's what struck me about England's organ donation story: it took a nine-year-old girl's death and another nine-year-old boy's survival to finally move an entire country to act. On May 20, 2020, England implemented Max and Keira's Law, officially the Organ Donation (Deemed Consent) Act 2019, shifting from an opt-in to an opt-out system. When I first read about Keira Ball and Max Johnson, I thought — why does it always take tragedy to change a default that should never have been the default in the first place?

What Changed

Under the previous system, individuals had to actively sign up to the NHS Organ Donor Register. The new law presumes that all adults in England agree to donate their organs when they die, unless they have explicitly recorded a decision not to donate, or are in an excluded group. Family members are still consulted before donation proceeds, and certain groups — including those under 18, people who lack mental capacity, and visitors to England — are exempt.

"Max is alive today because of organ donation. We want to help make sure other families don't have to go through the agony of waiting for a transplant." — Max's family, speaking in support of the law

The Story Behind the Name

Keira Ball's family made the decision to donate her organs after she was fatally injured in a car crash. Her heart saved the life of nine-year-old Max Johnson, who had been waiting for a transplant due to dilated cardiomyopathy. Max's family subsequently campaigned for the change in law, gathering over 36,000 signatures on a petition to Parliament. That kind of grassroots energy is exactly what we at YCOD believe in — ordinary people pushing for a system that makes the life-saving choice easier, not harder.

Early Results

NHS Blood and Transplant reported that the law helped normalize conversations about organ donation. In the first year, the NHS Organ Donor Register saw a notable increase in registrations, and refusal rates by families began to decrease — a critical factor, since family overrides had been a persistent barrier even in opt-out systems.

"The change in law is not about taking away people's choice. It's about shifting the default so that more lives can be saved." — NHS Blood and Transplant

Why This Matters for YCOD

This is the part I keep coming back to: changing the default saves lives. This isn't just a policy tweak — it's a fundamental shift in how a society treats organ donation. When donation becomes the expected norm rather than an exceptional choice, more families say yes, and more patients on the waitlist get the organs they need. After a family member needed a kidney transplant, this became personal for me. I couldn't stay on the sidelines watching 17 people die every day in the U.S. while countries like England were proving that a better way exists.

The success of Max and Keira's Law fuels our fight to pass Bill A07954 in New York. If England can do it, so can we.