Scotland's Deemed Authorization: Opt-Out Organ Donation Comes to the UK's North

Here's what I find compelling about Scotland's story: they watched Wales and England go first, learned from what worked and what didn't, and then built something even stronger. On March 26, 2021, Scotland became the third UK nation to implement an opt-out organ donation system with the Human Tissue (Authorisation) (Scotland) Act 2019. This isn't just another country following a trend — it's proof that each new adopter makes the case stronger for the next one.

Following Wales and England

Wales led the way in the UK with its opt-out system in 2015, followed by England in 2020. Scotland's approach built on lessons learned from both, with particular attention to public awareness campaigns and safeguards for vulnerable populations. The Scottish government invested significantly in public education before the law took effect, running campaigns under the banner "organ and tissue donation — it's worth talking about." That investment in education before implementation is something I think about a lot for New York.

"This law gives us the opportunity to save and transform more lives through organ and tissue donation. It's a landmark moment for Scotland." — Scottish Government Health Secretary

How It Differs

Scotland's system includes several notable features. It uses the term "deemed authorisation" rather than "presumed consent," emphasizing that the system authorises donation to proceed rather than presuming an individual's consent. The law also places particular emphasis on the role of the "nearest relative," who is consulted and can provide information about the deceased's wishes. Adults who had lived in Scotland for at least 12 months and had not opted out are covered.

Impact on Donation Rates

NHS Scotland reported increased engagement with the Organ Donor Register following implementation. The percentage of people actively recording their donation decision — whether to donate or not — rose significantly. Family refusal rates, which had been around 40% in Scotland prior to the law, began to decline as more families understood their loved one's wishes. Think about that: 40% of families were saying no before this law. That's not because people are against donation — it's because the system wasn't helping families make an informed decision at the hardest moment of their lives.

"When families know what their loved one wanted, they almost always honor that wish. This law helps make those wishes clear." — NHS Blood and Transplant Scotland

The Bigger Picture

With Wales, England, Scotland, and Northern Ireland (which is considering similar legislation), the entire United Kingdom is moving toward opt-out organ donation. I want to be direct about what this means: a major Western democracy — one that shares our legal traditions — is proving across all its nations that opt-out systems are practical, ethical, and effective. When 17 people die every day in the U.S. waiting for organs, we can't keep pretending this is some radical experiment. The evidence is in. We at YCOD are using the UK's example to push for Bill A07954 in New York, and the case gets stronger with every country that proves us right.