Organ donation
Making organ donation expected
Dr. Gail Miflin OBE and Professor John Forsythe OBE, Co-Chairs of the Organ Donation Joint Working Group, call for a bolder, braver approach for organ donation in the UK. They argue that the next step change in organ donation will not come from public awareness and policy alone, but from renewed clinical leadership.
Nearly 20 years after the Organ Donation Taskforce recommended that organ donation should become a usual and expected part of end-of-life care, progress has not reached this goal. This is why a new report - A bolder, braver approach for organ donation in the UK – has been launched by the Organ Donation Joint Working Group (ODJWG) – a group Jointly Chaired by the Department of Health and Social Care and NHS Blood and Transplant. The group brought together national and international organ donation experts from five countries, donor families and service providers, to identify actions to maximise the number of lives saved through the gift of deceased organ donation. This work built on the positive developments
(such as the change in legislation) and drew lessons from less successful approaches. Professor John Forsythe and Dr. Gail Miflin (co- chairs of the ODJWG) argue that the next step change in organ donation will not come from public awareness and policy alone, but from renewed clinical leadership, confidence and ownership at the bedside. The report lays out 10 ambitious actions for
improving organ donation rates and ultimately reducing the national transplant waiting list. Many of these are directly actionable by those in clinical settings who have the power to make a real difference. As with many countries, the UK is experiencing challenges with the number of proceeding organ donors and consent rates. In the UK, organ donation rates were showing steady recovery in the years post-pandemic, despite a fall in family consent rates. The latest UK data for 2024-2025 demonstrates a decline
in the pool of potential donors, 18% lower than pre pandemic, and a decline in the family consent rate, which is now 59% (compared to 68% pre-pandemic). This has contributed to the highest ever recorded number of people waiting for a lifesaving organ transplant (over 8,000). In addition, there is a decline in the number of people registering an expressed decision to donate on the NHS Organ Donor Register, even as recorded opt-out rates remain low (3.8%) by international standards. International experience is clear, clinical
practice and professional culture matter. In Spain, nearly a quarter of donors are identified outside the ICU, with patients transferred to intensive care settings when donation is
In the UK, donation remains largely ICU-centric. As a result, patients who die outside intensive care may never be offered the opportunity to donate.
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www.clinicalservicesjournal.com I May 2026
a possibility. Both Spain and Australia offer donation opportunities to patients dying in palliative care or outside hospital where this aligns with the person’s decision to be an organ donor. These approaches are grounded in patient autonomy and equity - not the necessity for transplant opportunities. In the UK, donation remains largely ICU- centric. As a result, patients who die outside intensive care may never be offered the opportunity to donate, even when donation reflects their values or recorded decisions. Sadly, this also includes corneal and other tissue donation, but that is beyond the scope of the Report and this paper. A positive donation culture is created when donation expertise is embedded within MDTs and shared ownership is the norm. The ODJWG heard that, while best practice can occur – where a joint clinical team meeting agrees a tailored approach to a potential donor family – this could morph into a rushed corridor conversation in some settings. International
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