The Netherlands Adopts Opt-Out Organ Donation: What It Means

Here's a detail about the Netherlands that stuck with me: their opt-out organ donation law passed the Senate by a single vote. One vote — 38 to 36. That's how close an entire country came to keeping a broken default in place. On July 1, 2020, the Netherlands enacted its new Donor Registration Act, and I think about that razor-thin margin every time someone tells me changing the system is impossible.

How the System Works

Under the new law, all Dutch residents aged 18 and older are contacted by letter and asked to register their organ donation preference. If they do not respond after two reminders, they are registered as having "no objection" to organ donation. Importantly, this is not automatic consent — family members are still consulted and can object on behalf of the deceased. Citizens can choose from four options: yes to donation, no to donation, let family decide, or let a specific person decide.

"This law does not force anyone to donate. It ensures that everyone makes a conscious choice, and if they don't, the default helps save lives." — Pia Dijkstra, sponsor of the bill

The Path to Passage

The legislation was championed by D66 party member Pia Dijkstra and took over six years to pass. Public opinion was deeply divided. Opponents argued the law infringed on bodily autonomy, while supporters pointed to the roughly 150 people who died each year in the Netherlands while waiting for an organ transplant. Six years of debate, 150 preventable deaths a year — that math should have made this an easy decision, but changing the default is never easy, even when it saves lives.

Impact So Far

After implementation, the Dutch Transplant Foundation reported increased public awareness. More people actively registered their preferences — whether yes or no — which itself was considered a positive outcome, as it reduced uncertainty for families facing donation decisions at the most difficult time imaginable. This is a point I make constantly: the goal isn't to force anyone into anything. It's to make sure people actually make a choice instead of leaving their families to guess.

"Even people who choose not to donate benefit from this system, because their wishes are clearly recorded." — Dutch Transplant Foundation

Lessons for the U.S.

The Dutch experience proves something I believe deeply: opt-out systems don't eliminate choice — they encourage it. The Netherlands saw a meaningful rise in active registrations of all types. We at YCOD point to this constantly. If New York passed Bill A07954, it wouldn't override anyone's autonomy — it would prompt more people to make their wishes known, lift the burden off grieving families, and save lives. After a family member needed a kidney transplant, this became personal for me. I couldn't stay on the sidelines knowing 17 people die every day in the U.S. while countries like the Netherlands are proving there's a better way.