Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK.
Bangor University, Bangor, UK.
Health Econ Policy Law. 2024 Jul;19(3):353-369. doi: 10.1017/S1744133124000112. Epub 2024 Sep 12.
In the three years since the law on adult deceased organ donation consent in England changed to include an opt-out system, there has been no discernible change to donation rates. The lack of a positive impact on donation rates was predicted by many of those who took part in debates before and during the passage of the Bill through Parliament. This invites the question as to why England moved to an opt-out system for organ donation despite equivocal evidence of likely benefit and opposition from expert health professional organisations. To address this question qualitative analyses of Parliamentary debates on organ donation was undertaken. This revealed a shift from a dominant position, which gave primacy to the evidence of likely effects, towards a more normative position where a deemed consent option was viewed as the 'correct thing to do' and the limited and conflicting evidence viewed in a positive light. By 2017, following Wales's move to an opt-out system, together with continued lobbying for similar changes for England by professional and patient groups, alongside sustained public popularity for organ donation, the balance of opinion had shifted towards a system where deemed consent would become the default position for most English adults.
自英格兰成人死后器官捐赠同意法改为包含选择退出系统以来的三年中，捐赠率没有明显变化。许多参与该法案在议会通过之前和期间的辩论的人预测，这对捐赠率不会产生积极影响。尽管有证据表明可能有好处，并且专家健康专业组织也持反对意见，但英格兰为何仍选择选择退出器官捐赠系统？为了解决这个问题，对议会关于器官捐赠的辩论进行了定性分析。这揭示了一个从优先考虑可能效果的主导地位向更规范的地位的转变，在这种地位下，被认为的同意选择被视为“正确的事情”，而有限和相互矛盾的证据则被正面看待。到 2017 年，继威尔士采用选择退出系统之后，专业和患者团体继续游说英格兰进行类似的改革，加上公众对器官捐赠的持续支持，舆论的平衡已转向默认系统，大多数英格兰成年人都将默认同意。
