Editing Organ donation (section)

==Legislation and global perspectives==
{{update|date=December 2020}}
The laws of different countries allow potential donors to permit or refuse donation, or give this choice to relatives. The frequency of donations varies among countries.

===Consent process===
The term consent is typically defined as a subject adhering to an agreement of principles and regulations; however, the definition becomes difficult to execute concerning the topic of organ donation, mainly because the subject is incapable of consent due to death or mental impairment.<ref name=":02"/> There are two types of consent being reviewed; explicit consent and presumed consent. Explicit consent consists of the donor giving direct consent through proper registration depending on the country.<ref name="Peltier">{{cite journal |last1=D'Alessandro |first1=Anthony M. |last2=Peltier |first2=James W. |last3=Dahl |first3=Andrew J. |title=Use of Social Media and College Student Organizations to Increase Support for Organ Donation and Advocacy: A Case Report |journal=Progress in Transplantation |date=December 2012 |volume=22 |issue=4 |pages=436–441 |doi=10.7182/pit2012920 |pmid=23187063 |s2cid=22015905 }}</ref> The second consent process is presumed consent, which does not need direct consent from the donor or the next of kin.<ref name="Peltier"/> Presumed consent assumes that donation would have been permitted by the potential donor if permission was pursued.<ref name="Peltier"/> Of possible donors an estimated twenty-five percent of families refuse to donate a loved one's organs.<ref>{{cite journal |last1=Siminoff |first1=Laura A. |last2=Agyemang |first2=Amma A. |last3=Traino |first3=Heather M. |title=Consent to Organ Donation: A Review |journal=Progress in Transplantation |date=March 2013 |volume=23 |issue=1 |pages=99–104 |doi=10.7182/pit2013801 |pmid=23448829 |pmc=6776471 }}</ref>

====Opt-in versus opt-out====
{{see also|Mandated choice}}

As medical science advances, the number of people who could be helped by organ donors increases continuously. As opportunities to save lives increase with new technologies and procedures, the demand for organ donors rises faster than the actual number of donors.<ref name="The Week (4)">{{cite web|title=Automatic organ donation: the pros and cons|url=http://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons|archive-url=https://web.archive.org/web/20160124030032/http://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons|url-status=dead|archive-date=January 24, 2016|website=The Week: Science and Health|access-date=September 1, 2016}}</ref> To respect individual autonomy, voluntary [[consent]] must be determined for the individual's disposition of their remains following death.<ref name="Cohen">{{cite journal |last1=Cohen |first1=Carl |title=The case for presumed consent to transplant human organs after death |journal=Transplantation Proceedings |date=October 1992 |volume=24 |issue=5 |pages=2168–2172 |pmid=1413020 }}</ref> There are two main methods for determining voluntary consent: "opt in" (only those who have given explicit consent are donors) and "opt out" (anyone who has not refused consent to donate is a donor). In terms of an opt-out or presumed consent system, it is assumed that individuals do intend to donate their organs to medical use when they expire.<ref name="Cohen"/> Opt-out legislative systems dramatically increase effective rates of consent for donation as a consequence of the [[default effect]].<ref name="do defaults save lives">{{cite journal |last1=Johnson |first1=Eric J. |last2=Goldstein |first2=Daniel |title=Do Defaults Save Lives? |journal=Science |date=November 21, 2003 |volume=302 |issue=5649 |pages=1338–1339 |doi=10.1126/science.1091721 |pmid=14631022 }}</ref> For example, Germany, which uses an opt-in system, has an organ donation consent rate of 12% among its population, while [[Austria]], a country with a very similar culture and economic development, but which uses an opt-out system, has a consent rate of 99.98%.<ref name="do defaults save lives"/><ref name="nytimes2009"/>

Opt-out consent, otherwise known as "deemed" consent, support refers to the notion that the majority of people support organ donation, but only a small percentage of the population are actually registered, because they fail to go through the actual step of registration, even if they want to donate their organs at the time of death. This could be resolved with an opt-out system, where many more people would be registered as donors when only those who object consent to donation have to register to be on the non-donation list.<ref name="Cohen"/>

For these reasons, countries, such as [[Wales]], have adopted a "soft opt-out" consent, meaning if a citizen has not clearly made a decision to register, then they will be treated as a registered citizen and participate in the organ donation process. Likewise, opt-in consent refers to the consent process of only those who are registered to participate in organ donation. Currently, the United States has an opt-in system, but studies show that countries with an opt-out system save more lives due to more availability of donated organs. The current opt-in consent policy assumes that individuals are not willing to become organ donors at the time of their death, unless they have documented otherwise through organ donation registration.<ref name="Cohen"/>

Registering to become an organ donor heavily depends on the attitude of the individual; those with a positive outlook might feel a sense of altruism towards organ donation, while others may have a more negative perspective, such as not trusting doctors to work as hard to save the lives of registered organ donors. Some common concerns regarding a presumed consent ("opt-out") system are sociologic fears of a new system, moral objection, sentimentality, and worries of the management of the objection registry for those who do decide to opt-out of donation.<ref name="Cohen"/> Additional concerns exist with views of compromising the freedom of choice to donate,<ref name="2012 National Survey of Organ Donation">{{cite journal |title=2012 National Survey of Organ Donation Attitudes and Behaviors|journal=U.S. Department of Health and Human Services: Health Research and Services Administration|date=September 2013|page=47<!--|pages=51-->}}</ref> conflicts with extant religious beliefs<ref name=Leins2016>{{cite news |last1=Leins |first1=Casey |title=Should the Government Decide if You're an Organ Donor? |url=https://www.usnews.com/news/articles/2016-02-12/presumed-consent-and-americas-organ-donor-shortage |work=U.S. News & World Report |date=February 12, 2016 }}</ref> and the possibility of posthumous violations of [[bodily integrity]].<ref>{{cite journal |last1=Qurashi |first1=G M |title=Opt-out paradigms for deceased organ donation are ethically incoherent |journal=Journal of Medical Ethics |date=December 2023 |volume=49 |issue=12 |pages=854–859 |doi=10.1136/medethics-2021-107630 |pmid=34509985 |s2cid=237490506 }}</ref> Even though concerns exist, the United States still has a 95 percent organ donation approval rate. This level of nationwide acceptance may foster an environment where moving to a policy of presumed consent may help solve some of the organ shortage problem, where individuals are assumed to be willing organ donors unless they document a desire to "opt-out", which must be respected.<ref name=Leins2016/>

Because of public policies, cultural, infrastructural and other factors, presumed consent or opt-out models do not always translate directly into increased effective rates of donation. The United Kingdom has several different laws and policies for the organ donation process, such as consent of a witness or guardian must be provided to participate in organ donation. This policy was consulted on by Department of Health and Social Care in 2018,<ref>{{cite web |url=https://engage.dh.gov.uk/organdonation/ |title=Archived copy |website=engage.dh.gov.uk |access-date=January 11, 2022 |archive-url=https://web.archive.org/web/20180123112022/https://engage.dh.gov.uk/organdonation/ |archive-date=January 23, 2018 |url-status=dead}}</ref> and was implemented starting May 20, 2020.<ref>{{Cite journal |last=Mahenthran |first=Thakshayene |date=January 2021 |title=The new 'opt-out' organ donation English law: Is the NHS ready for this? |journal=Clinical Medicine |volume=21 |issue=1 |pages=e92–e93 |doi=10.7861/clinmed.2020-0675 |issn=1470-2118 |pmc=7850211 |pmid=33479084}}</ref>

In terms of effective organ donations, in some systems like Australia (14.9 donors per million, 337 donors in 2011), family members are required to give consent or refusal, or may veto a potential recovery even if the donor has consented.<ref name=mythbusting/> Some countries with an opt-out system like Spain (40.2 donors per million inhabitants),<ref name= infographic2017>{{cite web|url=https://www.edqm.eu/sites/default/files/infographic-eodd-2017-web.pdf|date=December 30, 2018|publisher=European Directorate for the Quality of Medicines & HealthCare|title=Bring back hope to patients on waiting lists all over Europe!|type=infographic|access-date=December 30, 2018|archive-url=https://web.archive.org/web/20170907022202/http://www.edqm.eu/sites/default/files/infographic-eodd-2017-web.pdf|archive-date=September 7, 2017|url-status=dead}}</ref> [[Croatia]] (40.2 donors/million)<ref name= infographic2017/> or [[Belgium]] (31.6 donors/million)<ref name= infographic2017/> have high donor rates, however some countries such as [[Greece]] (6 donors/million) maintain low donor rates even with this system.<ref>{{cite journal |last1=Sotiropoulos |first1=Georgios C |last2=Machairas |first2=Nikolaos |title=Organ donation during the financial crisis in Greece |journal=The Lancet |date=September 2016 |volume=388 |issue=10048 |pages=957–958 |doi=10.1016/s0140-6736(16)31488-x |pmid=27598669 |s2cid=46419956 |doi-access=free }}</ref> The president of the Spanish [[National Transplant Organisation]] has acknowledged Spain's legislative approach is likely not the primary reason for the country's success in increasing the donor rates, starting in the 1990s.<ref name="ReferenceA">{{cite web|url=http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_090303.pdf|title=The potential impact of an opt out system for organ donation in the UK.|author=Organ Donation Taskforce|year=2008|publisher=[[Department of Health (United Kingdom)|Department of Health]]|location=United Kingdom|page=22|archive-url=http://webarchive.nationalarchives.gov.uk/20130107105354/http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_090303.pdf|archive-date=January 7, 2013|url-status=dead|access-date=March 8, 2014|author-link=Organ Donation Taskforce}}</ref>

Looking to the example of Spain, which has successfully adopted the presumed consent donation system, [[intensive care units]] (ICUs) must be equipped with enough doctors to maximize the recognition of potential donors and maintain organs while families are consulted for donation. The characteristic that enables the Spanish presumed consent model to be successful is the resource of [[Organ transplantation|transplant]] coordinators; it is recommended to have at least one at each hospital where opt-out donation is practiced to authorize organ procurement efficiently.<ref>{{cite journal |last1=Rodríguez-Arias |first1=David |last2=Wright |first2=Linda |last3=Paredes |first3=David |title=Success factors and ethical challenges of the Spanish Model of organ donation |journal=The Lancet |date=September 2010 |volume=376 |issue=9746 |pages=1109–1112 |doi=10.1016/S0140-6736(10)61342-6 |pmid=20870101 |s2cid=46708934 }}</ref>

Public views are crucial to the success of opt-out or presumed consent donation systems. In a study done to determine if [[health policy]] change to a presumed consent or [[opt-out]] system would help to increase donors, an increase of 20 to 30 percent was seen among countries who changed their policies from some type of opt-in system to an opt-out system. Of course, this increase must have a great deal to do with the [[health policy]] change, but also may be influenced by other factors that could have impacted donor increases.<ref name="Rithalia (6)">{{cite journal |last1=Rithalia |first1=A |last2=McDaid |first2=C |last3=Suekarran |first3=S |last4=Norman |first4=G |last5=Myers |first5=L |last6=Sowden |first6=A |title=A systematic review of presumed consent systems for deceased organ donation |journal=Health Technol |date=2009 |volume=13 |issue=26 |pages=iii, ix–xi, 1–95 |doi=10.3310/hta13260|pmid=19422754 |doi-access=free }}</ref>

Transplant Priority for Willing Donors, also known as the "donor-priority rule", is a newer method and the first to incorporate a "non-medical" criterion into the priority system to encourage higher donation rates in the opt-in system.<ref name="Dai 2020 622–641">{{cite journal |last1=Dai |first1=Tinglong |last2=Zheng |first2=Ronghuo |last3=Sycara |first3=Katia |title=Jumping the Line, Charitably: Analysis and Remedy of Donor-Priority Rule |journal=Management Science |date=February 2020 |volume=66 |issue=2 |pages=622–641 |doi=10.1287/mnsc.2018.3266 |s2cid=54028044 }}</ref><ref>{{cite news |last1=Ofri |first1=Danielle |title=In Israel, a New Approach to Organ Donation |url=https://archive.nytimes.com/well.blogs.nytimes.com/2012/02/16/in-israel-a-new-approach-to-organ-donation/ |work=Well |publisher=The New York Times |date=February 16, 2012 }}</ref> Initially implemented in Israel, it allows an individual in need of an organ to move up the recipient list. Moving up the list is contingent on the individual opting-in prior to their need for an organ donation. The policy applies nonmedical criteria when allowing individuals who have previously registered as an organ donor, or whose family has previously donated an organ, priority over other possible recipients. It must be determined that both recipients have identical medical needs prior to moving a recipient up the list. While incentives like this in the opt-in system do help raise donation rates, they are not as successful in doing so as the opt-out, presumed consent default policies for donation.<ref name=mythbusting>{{cite web |title = Myth busting|url = http://www.donatelife.gov.au/discover/mythbusting|at = My family can overrule my decision to be a donor|access-date = May 15, 2013|archive-date = May 22, 2013 |archive-url = https://web.archive.org/web/20130522024547/http://www.donatelife.gov.au/discover/mythbusting|website = DonateLife|publisher = Australian Government Organ and Tissue Authority}}</ref>
{| class="wikitable"
|+
! colspan="2" |Country
!Policy
!Year implemented
|-
| colspan="2" |Argentina
|opt-out
|2005
|-
| colspan="2" |Austria
|opt-out
|
|-
| colspan="2" |Belarus
|opt-out
|2007<ref>{{cite web | url=http://center.gov.by/publikatsii-rabotnikov-tsentra/kommentarii-zakonodatel-stva/kommentarij-k-zakonu-respubliki-bela-7/ | title=Комментарий к Закону Республики Беларусь "О внесении изменений и дополнений в Закон Республики Беларусь "О трансплантации органов и тканей человека" | access-date=January 4, 2023 | archive-date=January 4, 2023 | archive-url=https://web.archive.org/web/20230104091918/http://center.gov.by/publikatsii-rabotnikov-tsentra/kommentarii-zakonodatel-stva/kommentarij-k-zakonu-respubliki-bela-7/ | url-status=dead }}</ref>
|-
| colspan="2" |Belgium
|opt-out
|
|-
| colspan="2" |Brazil
|opt-in
|
|-
| colspan="2" |Czech Republic
|opt-out
|September 2002<ref>{{cite news |title=Enabling foreigners to become organ donors |url=https://english.radio.cz/enabling-foreigners-become-organ-donors-8561095 |work=Radio Prague International |date=August 22, 2011 }}</ref>
|-
| colspan="2" |Chile
|opt-out
|2010
|-
| colspan="2" |Colombia
|opt-out
|2017
|-
| colspan="2" |Guatemala
|opt-in
|February 2024<ref>{{Cite web |date=February 28, 2024 |title=¿Qué órganos se pueden donar y quiénes pueden ser donantes? |url=https://www.prensalibre.com/guatemala/politica/que-organos-se-pueden-donar-y-quienes-pueden-ser-donantes/ |access-date=2024-03-26 |language=es-GT}}</ref>
|-
| colspan="2" |Israel
|opt-in
|
|-
| colspan="2" |Netherlands
|opt-out
|2020<ref>[https://dutchreview.com/news/organ-donation-on-the-rise-in-the-netherlands/ The Netherlands is seeing more permissions for organ donation]</ref>
|-
| colspan="2" |Spain
|opt-out
|1979
|-
| colspan="2" |Ukraine
|opt-in
|<ref>{{cite news |last1=Panasytska |first1=Oleksandra |title=Donate An Organ And Save Your Neighbor's Life. What Is Happening With The Transplant System In Ukraine? |url=https://voxukraine.org/en/donate-an-organ-and-save-your-neighbor-s-life-what-is-happening-with-the-transplant-system-in-ukraine/ |work=Vox Ukraine |date=July 5, 2021 }}</ref>
|-
| rowspan="4" |United Kingdom
|Wales 
| rowspan="4" |opt-out
|December 1, 2015<ref>{{cite web |title=Organ donation law in Wales |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-wales/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|England 
|May 20, 2020<ref>{{cite web |title=Organ donation law in England |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-england/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|Scotland
|March 25, 2021<ref name=":6">{{cite web |title=Organ and tissue donation law in Scotland |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-scotland/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
|Northern  Ireland
|June 1, 2023<ref name=":7">{{cite web |title=Organ donation law in Northern Ireland |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-northern-ireland/ |access-date=2024-10-10 |website=NHS Organ Donation |publisher=NHS Blood and Transplant}}</ref>
|-
| colspan="2" |United States
|opt-in
|
|}

===Argentina===
On November 30, 2005, the [[National Congress of Argentina|Congress]] introduced an opt-out policy on organ donation, where all people over 18 years of age will be organ donors unless they or their family state otherwise. The law was promulgated on December 22, 2005, as "Law 26,066".<ref>{{cite web |url=http://servicios.infoleg.gob.ar/infolegInternet/verNorma.do?id=112375 |title=Law 26,066 |website=InfoLEG}}</ref>

On July 4, 2018, the Congress passed a law removing the family requirement, making the organ donor the only person that can block donation. It was [[promulgated]] on July 4, 2018, as Law Justina or "Law 27,447".<ref>{{Cite news |url=https://www.infobae.com/politica/2018/07/26/el-gobierno-promulgo-la-ley-justina-que-modifica-el-regimen-de-donacion-de-organos/ |title=El Gobierno promulgó la "ley Justina" que modifica el régimen de donación de órganos |date=July 26, 2018 |work=[[Infobae]]}}</ref>

===Brazil===
A campaign by [[Sport Club Recife]] has led to waiting lists for organs in north-east Brazil to drop almost to zero; while according to the Brazilian law the family has the ultimate authority, the issuance of the organ donation card and the ensuing discussions have however eased the process.<ref>{{Cite news|url = https://www.bbc.com/news/magazine-27632527|title = How thousands of football fans are helping to save lives|last = Carneiro|first = Julia |date=June 1, 2014 |work = BBC News Magazine}}</ref>

===Canada===
In 2001, the Government of Canada announced the formation of the Canadian Council for Donation and Transplantation, whose purpose would be to advise the Conference of Deputy Ministers of Health on activities relating to organ donation and transplantation. The deputy ministers of health for all provinces and territories with the exception of [[Québec]] decided to transfer the responsibilities of the Canadian Council for Donation and Transplantation to [[Canadian Blood Services]].<ref>{{Cite web|url = http://publications.gc.ca/collections/collection_2018/bdp-lop/bp/YM32-2-2018-13-eng.pdf|title = Organ Donation and Transplantation in Canada|last = Norris|first = Sonya |date=February 14, 2018 |access-date= September 30, 2019}}</ref>

In Québec, an organization called Transplant Québec is responsible for managing all organ donation; Héma-Québec is responsible for tissue donation.<ref>{{Cite web|url =https://www.quebec.ca/en/health/blood-tissue-and-organ-donation/organ-and-tissue-donation/| date = July 15, 2019 |access-date = November 26, 2019|title = Organ and tissue donation | website = Québec}}</ref> Consent for organ donation by an individual is given by either registering with the organ donation registry established by the {{Lang|fr|Chambre des notaires du Québec|italic=no}}, signing and affixing the sticker to the back of one's health insurance card, or registering with either {{Lang|fr|Régie de l'assurance maladie du Québec|italic=no}} or {{Lang|fr|Registre des consentements au don d'organes et de tissus|italic=no}}.<ref>{{Cite web| url = https://www.transplantquebec.ca/en/how-register|access-date = November 26, 2019|title= How to Register| website = Transplant Québec}}</ref>

{{Pie chart
| thumb = left
| caption = Number of transplants by organ<ref name=BloodRpt>{{Cite web |url = https://blood.ca/sites/default/files/System_Progress_Report_2017_Update_FINAL-EN.pdf |title = Organ Donation and Transplantation in Canada System Progress Report |access-date = September 30, 2019 |website = Canadian Blood Services |archive-date = March 8, 2021 |archive-url = https://web.archive.org/web/20210308094856/https://www.blood.ca/sites/default/files/System_Progress_Report_2017_Update_FINAL-EN.pdf |url-status = dead }}</ref>
| label1 =[[Kidney]]
| value1 =58.5
| color1 =#800080
| label2 =[[Liver]]
| value2 =19.8
| color2 =#0000FF
| label3 =[[Lung]]
| value3 =11.8
| color3 =#008000
| label4 =[[Heart]]
| value4 =7.3
| color4 =#FF0000
| label5 =[[Pancreas]]
| value5 =1.1
| color5 =#808080
| label6 =Kidney and Pancreas
| value6 =1.5
| color6 =#FF00FF
}} In 2017, the majority of transplants completed were kidney transplants.<ref name=BloodRpt/> Canadian Blood Services has a program called the kidney paired donation, where transplant candidates are matched with compatible living donors from all over Canada. It also gives individuals an opportunity to be a living donor for an anonymous patient waiting for a transplant. As of December 31, 2017, there were 4,333 patients on the transplant waitlist. In 2017, there were a total of 2,979 transplants, including multi-organ transplants; 242 patients died while on the waitlist. 250 Canadians die on average waiting for transplant organs every year.<ref>{{Cite web| url = https://blood.ca/sites/default/files/10880-ENG-KPD_Brochure_2019-03-01.pdf|title = Kidney Paired Donation|date = March 1, 2019|access-date = September 30, 2019 |website=Canadian Blood Services}}</ref>

Each province has different methods and registries for intent to donate organs or tissues as a deceased donor. In some provinces, such as [[Newfoundland and Labrador]] and [[New Brunswick]] organ donation registration is completed by completing the "Intent to donate" section when applying or renewing one's provincial medical care.<ref>{{Cite web|url = https://www2.gnb.ca/content/gnb/en/departments/health/Hospital-Services/content/organ_donation.html| title = New Brunswick Organ & Tissue Donation Program | website = Government of New Brunswick | date = September 2015 | access-date = November 26, 2019}}</ref><ref>{{Cite web|url = http://www.easternhealth.ca/Give.aspx?d=1&id=323&p=53|title = Organ Donation | website = Eastern Health Newfoundland and Labrador |access-date = September 30, 2019| date = April 18, 2017}}</ref> In [[Ontario]], one must be 16 years of age to register as an organ and tissue donor and register with [[ServiceOntario]].<ref>{{Cite web|url = https://www.ontario.ca/page/organ-and-tissue-donor-registration| access-date = November 26, 2019 | title = Organ and tissue donor registration | website = Province of Ontario | date = November 18, 2019}}</ref> [[Alberta]] requires that a person must be 18 years of age or older and register with the Alberta Organ and Tissue Donation Registry.<ref>{{Cite web| url = https://myhealth.alberta.ca/alberta/Pages/organ-and-tissue-donation-consent-to-donate.aspx| title = Organ and Tissue Donation in Alberta | date = March 28, 2019 |website = myhealthAlberta |access-date = November 26, 2019}}</ref>

====Opt-out donation in Canada====
[[Nova Scotia]], Canada, is the first jurisdiction in North America to introduce an automatic organ donation program unless residents opt out; what the province refers to as [[Informed consent|deemed consent]].<ref>{{Cite web|url=https://www.cbc.ca/news/canada/nova-scotia/presumed-automatic-consent-organ-donation-1.5081272|title=Nova Scotia to become 1st in North America with presumed consent for organ donation|last=Gorman|first=Michael|date=April 2, 2019|website=CBC News|access-date=November 26, 2019}}</ref> The Human Organ and Tissue Act was introduced on April 2, 2019.<ref>{{Cite web|url = https://novascotia.ca/news/release/?id=20190402003|title = Government Introduces Legislation to Increase Organ and Tissue Donation| date = April 2, 2019|access-date = November 26, 2019|website = Province of Nova Scotia}}</ref> With the legislation, all people who have been Nova Scotia residents for a minimum of 12 consecutive months, with appropriate decision-making capacity and are over 18 years of age are considered potential donors and will be automatically referred to donation programs if they are determined to be good candidates. In the case of persons under 18 years of age and people without appropriate decision-making capacity, they will only be considered as organ donors if their parent, guardian or decision-maker opts them into the program. The legislation took effect on January 18, 2021.<ref>{{cite web |title=Changes to organ and tissue donation |date=June 30, 2020 |url=https://novascotia.ca/organ-and-tissue-donation-changes/ |publisher=Nova Scotia Health |access-date=29 November 2024}}</ref>

===Chile===
On January 6, 2010, the "Law 20,413" was promulgated, introducing an opt-out policy on organ donation, where all people over 18 years of age will be organ donors unless they state their negative.<ref>[http://www.minsal.cl/introduccion-trasplantes/ Ministerio de Salud – Introducción Trasplantes]</ref><ref>{{cite web|url=https://www.leychile.cl/Navegar?idNorma=1010132|title=LEY-20413 15-ENE-2010 MINISTERIO DE SALUD, SUBSECRETARÍA DE SALUD PÚBLICA – Ley Chile – Biblioteca del Congreso Nacional|date=January 15, 2010}}</ref>

===Colombia===
On August 4, 2016, the [[Congress of Colombia|Congress]] passed the "Law 1805", which introduced an opt-out policy on organ donation where all people will be organ donors unless they state their negative.<ref>{{cite web|url=http://es.presidencia.gov.co/normativa/normativa/LEY%201805%20DEL%2004%20DE%20AGOSTO%20DE%202016.pdf |archive-url=https://web.archive.org/web/20161009215507/http://es.presidencia.gov.co/normativa/normativa/LEY%201805%20DEL%2004%20DE%20AGOSTO%20DE%202016.pdf |archive-date=2016-10-09 |url-status=live|title=Ley 1805}}</ref> The law came into force on February 4, 2017.<ref>{{cite web|url=https://www.publimetro.co/co/colombia/2017/02/04/donacion-organos-obligatoria.html|title=Desde hoy la donación de órganos es obligatoria|website=Publimetro Colombia|date=February 4, 2017 }}</ref>

===Europe===
[[File:IntlOrgan.png|thumb|Map showing the coverage of three international European organ donation associations:
{{legend|#990030|[[Balttransplant]]}}{{legend|#2F3699|[[Eurotransplant]]}}{{legend|#22B14C|[[Scandiatransplant]]}}]]
Within the European Union, organ donation is regulated by member states. As of 2010, 24 European countries have some form of presumed consent (opt-out) system, with the most prominent and limited opt-out systems in Spain, Austria, and Belgium yielding high donor rates.<ref name=huffingtonpost>{{cite news | first=Michael | last=Gormley | url=https://www.huffingtonpost.com/2010/04/27/new-york-to-be-first-orga_n_554234.html | title=New York To Be First Organ Donor Opt-Out State? | work=[[The Huffington Post]] | location=New York City | department=New York | access-date=March 7, 2014 | date=April 27, 2010 | url-status=live | archive-date=April 30, 2010 | archive-url=https://web.archive.org/web/20100430150649/http://www.huffingtonpost.com/2010/04/27/new-york-to-be-first-orga_n_554234.html}}</ref> Spain had the highest donor rate in the world, 46.9 per million people in the population, in 2017.<ref>{{cite news |title=Spain leads the world in organ donation. What's stopping other countries catching up? |url=https://mosaicscience.com/story/spain-uk-organ-donation-transplants-liver-kidney-heart-lungs-surgery-nhs/ |access-date=September 7, 2018 |publisher=Mosaic Science |date=August 6, 2018}}</ref> This is attributed to multiple factors in the Spanish medical system, including identification and early referral of possible donors, expanding criteria for donors and standardised frameworks for transplantation after circulatory death.<ref>{{cite journal |last1=Matesanz |first1=R. |last2=Domínguez-Gil |first2=B. |last3=Coll |first3=E. |last4=Mahíllo |first4=B. |last5=Marazuela |first5=R. |title=How Spain Reached 40 Deceased Organ Donors per Million Population |journal=American Journal of Transplantation |date=June 2017 |volume=17 |issue=6 |pages=1447–1454 |doi=10.1111/ajt.14104 |pmid=28066980 |doi-access=free }}</ref>

In England, individuals who wish to donate their organs after death can use the Organ Donation Register, a national database. The government of Wales became the first constituent country in the UK to adopt presumed consent in July 2013.<ref name=BBCwalesOrgan>{{cite news |title=Organ donation opt-out system given go-ahead in Wales |url=https://www.bbc.com/news/uk-wales-politics-23143236 |work=[[BBC News]] |date=July 2, 2013 }}</ref> The opt-out organ donation scheme in Wales went live on December 1, 2015, and is expected to increase the number of donors by 25%.<ref>{{cite news|title=Organ donation law 'revolution' starts in Wales|url=https://www.bbc.co.uk/news/uk-wales-34964382|access-date=December 1, 2015 |publisher=BBC}}</ref> In 2008, the UK discussed whether to switch to an opt-out system in light of the success in other countries and a severe British organ donor shortfall.<ref name=bbc7358789>{{cite news |title=MEPs back Europe organ donor card |url=http://news.bbc.co.uk/2/hi/health/7358789.stm |work=[[BBC News]] |date=April 22, 2008 }}</ref> In Italy if the deceased neither allowed nor refused donation while alive, relatives will pick the decision on his or her behalf despite a 1999 act that provided for a proper opt-out system.<ref name="Ministry of Health (Italy)">{{cite news | url=http://www.trapianti.salute.gov.it/cnt/cntDettaglioMenu.jsp?id=5&area=cnt-generale&menu=menuPrincip... | language=it | title=Come donare |trans-title=How to Donate | publisher=Ministry of Health (Italy) | access-date=January 13, 2013 | archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308225612/http://www.trapianti.salute.gov.it/cnt/cntDettaglioMenu.jsp?id=5&area=cnt-generale&menu=menuPrincip...}}</ref> In 2008, the [[European Parliament]] overwhelmingly voted for an initiative to introduce an EU organ donor card to foster organ donation in Europe.<ref>{{Cite web |last=ADAMOU |first=Adamos |title=Report on organ donation and transplantation: Policy actions at EU level {{!}} A6-0090/2008 {{!}} European Parliament |url=https://www.europarl.europa.eu/doceo/document/A-6-2008-0090_EN.html |access-date=2024-02-09 |website=www.europarl.europa.eu |language=en}}</ref>

[[Landstuhl Regional Medical Center]] (LRMC) has become one of the most active organ donor hospitals in all of Germany, which otherwise has one of the lowest organ donation participation rates in the [[Eurotransplant]] organ network. LRMC, the largest U.S. military hospital outside the United States, is one of the top hospitals for organ donation in the [[Rhineland-Palatinate]] state of Germany, even though it has relatively few beds compared to many German hospitals. According to the German [[organ transplantation]] organization, {{Lang|de|Deutsche Stiftung Organtransplantation|italic=no}} (DSO), 34 American military service members who died at LRMC (roughly half of the total number who died there) donated a total of 142 organs between 2005 and 2010. In 2010 alone, 10 of the 12 American service members who died at LRMC were donors, donating a total of 45 organs. Of the 205 hospitals in the DSO's central region—which includes the large cities of [[Frankfurt]] and [[Mainz]]—only six had more organ donors than LRMC in 2010.<ref name=Jones2011>{{cite news | last=Jones | first=Meg | title=A Soldier's Death Gives Life to Another Man | publisher=Pulitzer Center on Crisis Reporting | location=United States | date=April 23, 2011 | url=http://pulitzercenter.org/articles/germany-us-hospital-landstuhl-organ-donations | access-date=March 8, 2014 | url-status=live | archive-date=August 26, 2013 | archive-url= https://web.archive.org/web/20130826220345/http://pulitzercenter.org/articles/germany-us-hospital-landstuhl-organ-donations}}</ref>

Scotland conforms to the Human Tissue Authority Code of Practice, which grants authority to donate organs, instead of consent of the individual.<ref name=":02">{{cite journal |last1=Vincent |first1=A. |last2=Logan |first2=L. |title=Consent for organ donation |journal=British Journal of Anaesthesia |date=January 2012 |volume=108 |pages=i80–i87 |doi=10.1093/bja/aer353 |pmid=22194436 |doi-access=free }}</ref> This helps to avoid conflict of implications and contains several requirements. To participate in organ donation, one must be listed on the Organ Donor Registry (ODR). If the subject is incapable of providing consent, and is not on the ODR, then an acting representative, such as a legal guardian or family member can give legal consent for organ donation of the subject, along with a presiding witness, according to the Human Tissue Authority Code of Practice. Consent or refusal from a spouse, family member, or relative is necessary for a subject is incapable.

Austria participates in the "opt-out" consent process, and have laws that make organ donation the default option at the time of death. In this case, citizens must explicitly "opt out" of organ donation. Yet in countries such as U.S.A. and Germany, people must explicitly "opt in" if they want to donate their organs when they die. In Germany and Switzerland there are [[Organ Donor Card]]s available.<ref>{{Cite news|url=https://service.Bzga.de/pdf.php?id=02649655674b4cc79d27d1ad75f99448|title=Organ Donor Card from Germany in English (PDF)}}</ref><ref>{{Cite news|url=https://www.Leben-ist-teilen.ch/uploads/order-shop/TalkAboutOrganDonation.pdf |archive-url=https://web.archive.org/web/20181125123152/https://www.leben-ist-teilen.ch/uploads/order-shop/TalkAboutOrganDonation.pdf |archive-date=2018-11-25 |url-status=live|title=Some Information about the Swiss Organ Donor Card in English(PDF)}}</ref>

In May 2017, Ireland began the process of introducing an "opt-out" system for organ donation. Minister for Health, Simon Harris, outlined his expectations to have the Human Tissue Bill passed by the end of 2017. This bill would put in place the system of "presumed consent".<ref>{{Cite news|url=https://www.irishtimes.com/news/health/harris-planning-organ-donation-opt-out-system-1.3075447|title=Harris planning organ donation 'opt-out' system|newspaper=The Irish Times|access-date=May 9, 2017}}</ref>

The Mental Capacity Act is another legal policy in place for organ donation in the UK. The act is used by medical professionals to declare a patient's mental capacity. The act claims that medical professionals are to "act in a patient's best interest", when the patient is unable to do so.<ref name=":02"/>

===India===
{{See also|Organ donation in India}}
India has a fairly well developed corneal donation programme; however, donation after brain death has been relatively slow to take off. Most of the transplants done in India are living related or unrelated transplants. To curb organ commerce and promote donation after brain death the government enacted a law called "[[Transplantation of Human Organs and Tissues Act, 1994|The Transplantation of Human Organs Act]]" in 1994 that brought about a significant change in the organ donation and transplantation scene in India.<ref name=vyas2013>{{cite news
 | url=http://timesofindia.indiatimes.com/city/bangalore/State-goes-slow-on-stiffer-jail-term-for-organ-scamsters/articleshow/18011712.cms | title=State goes slow on stiffer jail term for organ scamsters | work=[[The Times of India]] | date=January 14, 2013 | access-date=March 7, 2014 | author=Vyas, Hetel | url-status=live | archive-date=March 8, 2014| archive-url=https://web.archive.org/web/20140308003903/http://timesofindia.indiatimes.com/city/bangalore/State-goes-slow-on-stiffer-jail-term-for-organ-scamsters/articleshow/18011712.cms}}</ref><ref name="kurup2013">{{cite news | url=http://www.thehindu.com/news/cities/bangalore/expendable-cogs-in-a-welloiled-racket/article4270073.ece | title=Expendable cogs in a well-oiled racket | work=[[The Hindu]] | date=January 4, 2013 | access-date=March 7, 2014 | author=Kurup, Deepa | location=India | url-status=live | archive-url=https://web.archive.org/web/20130310060441/http://www.thehindu.com/news/cities/bangalore/expendable-cogs-in-a-welloiled-racket/article4270073.ece | archive-date=March 10, 2013 | df=mdy-all }}</ref><ref name="zeenews20110317">{{cite news
 | url=http://zeenews.india.com/news/nation/govt-amends-transplantation-of-human-organs-act_693974.html | title=Govt amends Transplantation of Human Organs Act | work=[[Zee News]] | date=March 17, 2011 | access-date=March 7, 2014 | location=India | url-status=live | archive-date=March 8, 2014| archive-url=https://web.archive.org/web/20140308005425/http://zeenews.india.com/news/nation/govt-amends-transplantation-of-human-organs-act_693974.html}}</ref><ref name=thehindu20130307>{{cite news | url=http://www.thehindu.com/sci-tech/health/policy-and-issues/national-workshop-of-transplant-coordinators-provides-guidelines/article4484428.ece | title=National Workshop of transplant coordinators provides guidelines | work=[[The Hindu]] | date=March 7, 2013 | access-date=March 7, 2014 | location=India | url-status=live | archive-date=May 11, 2013 | archive-url=https://web.archive.org/web/20130511001203/http://www.thehindu.com/sci-tech/health/policy-and-issues/national-workshop-of-transplant-coordinators-provides-guidelines/article4484428.ece}}</ref><ref name=dhar2009>{{cite news | url=http://www.thehindu.com/news/national/organ-transplant-bill-tabled/article67126.ece | title=Organ Transplant Bill tabled | work=[[The Hindu]] | date=December 19, 2009 | access-date=March 8, 2014 | author=Dhar, Aarti | url-status=live | archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308032121/http://www.thehindu.com/news/national/organ-transplant-bill-tabled/article67126.ece}}</ref><ref name="lks2011">{{cite act | title=The Transplantation of Human Organs (Amendment) Bill, 2011 | number=136-C | year=2009 | url=http://164.100.24.219/BillsTexts/LSBillTexts/PassedLoksabha/Transp%20136-C%202009%20ENG.pdf |archive-url=https://web.archive.org/web/20161101041712/http://164.100.24.219/BillsTexts/LSBillTexts/PassedLoksabha/Transp%20136-C%202009%20ENG.pdf |archive-date=2016-11-01 |url-status=live | access-date=March 8, 2014}}</ref><ref name="shroffiju2009">{{cite journal |last1=Shroff |first1=Sunil |title=Legal and ethical aspects of organ donation and transplantation |journal=Indian Journal of Urology |date=2009 |volume=25 |issue=3 |pages=348–355 |doi=10.4103/0970-1591.56203 |doi-access=free |pmid=19881131 |pmc=2779960 }}</ref> Many Indian states have adopted the law and in 2011 further amendment of the law took place.<ref name="hindu20110813">{{cite news |url=http://www.thehindu.com/news/national/illegal-organ-transplant-can-attract-10year-jail/article2351612.ece | title=Illegal organ transplant can attract 10-year jail |work=[[The Hindu]] |date=August 13, 2011 |access-date=March 8, 2014 |url-status=live |archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308035000/http://www.thehindu.com/news/national/illegal-organ-transplant-can-attract-10year-jail/article2351612.ece}}</ref><ref name=orgthoa2011>{{cite web | url=http://www.orbo.org.in/Doc/Ann%204%20THOA%20ACT%202011.pdf | access-date=March 8, 2014 | url-status=dead | archive-date=March 8, 2014 | title=Ann 4 THOA ACT 2011 | publisher=Organ Retrieval Banking Organization | archive-url=https://web.archive.org/web/20140308192251/http://www.orbo.org.in/Doc/Ann%204%20THOA%20ACT%202011.pdf }}</ref><ref name=indiatoday20110813>{{cite news | url=http://indiatoday.intoday.in/story/lok-sabha-approves-tougher-organ-transplant-bill/1/147983.html | title=Lok Sabha approves tougher organ transplant Bill | date=August 13, 2011 | work=[[India Today]] | url-status=live |archive-date=August 21, 2013 | archive-url=https://web.archive.org/web/20130821014516/http://indiatoday.intoday.in/story/lok-sabha-approves-tougher-organ-transplant-bill/1/147983.html}}</ref><ref>{{cite news | title=RS seal on amendment to human organs bill | url=http://timesofindia.indiatimes.com/india/RS-seal-on-amendment-to-human-organs-bill/articleshow/9752631.cms | work=[[The Times of India]] | date=August 27, 2011 }}</ref><ref name="ens2011813">{{cite news | url=http://archive.indianexpress.com/news/ls-okays-amendments-to-organ-transplantation-bill/831356/ | title=LS okays amendments to organ transplantation Bill | work=[[The Indian Express]] | date=August 13, 2011 | access-date=March 7, 2014 | author=Express News Service | location=India | url-status=live | department=Archive | archive-date=March 8, 2014| archive-url=https://web.archive.org/web/20140308000716/http://archive.indianexpress.com/news/ls-okays-amendments-to-organ-transplantation-bill/831356/}}</ref> Despite the law there have been stray instances of organ trade in India and these have been widely reported in the press. This resulted in the amendment of the law further in 2011. Deceased donation after brain death have slowly started happening in India and 2012 was the best year for the programme.
[[File:India (orthographic projection).svg|thumb|India]]

{| style="width: 40%" border="1" class="organdonationtab"
|+ '''Table 1 – Deceased Organ Donation in India – 2012.'''
! State !! No. of Deceased Donors !! Total no. of Organs Retrieved !! Organ Donation Rate per Million Population
|- style="text-align:center"
| style="width:100pt;"| Tamil Nadu || 83 || 252 || 1.15
|- style="text-align:center"
| Maharashtra || 29 || 68 || 0.26
|- style="text-align:center"
| Gujarat || 18 || 46 || 0.30
|- style="text-align:center"
| Karnataka || 17 || 46 || 0.28
|- style="text-align:center"
| Andhra Pradesh || 13 || 37 || 0.15
|- style="text-align:center"
| Kerala || 12 || 26 || 0.36
|- style="text-align:center"
| Delhi-NCR || 12 || 31|| 0.29
|- style="text-align:center"
| Punjab || 12 || 24 || 0.43
|- style="text-align:center"
! Total !! 196 !! 530 !! 0.16
|}
* Source the Indian Transplant News Letter of the [[MOHAN Foundation]]<ref>{{cite web|url=http://www.mohanfoundation.org/regis/login.asp?sendto=../newsletters/pdf/Indian-Transplant-Newsletter-37.pdf|title=MOHAN Foundation – Member Login|website=www.mohanfoundation.org}}</ref>

The year 2013 has been the best yet for deceased organ donation in India. A total of 845 organs were retrieved from 310 multi-organ donors resulting in a national organ donation rate of 0.26 per million population(Table 2).
{| class="stats" style="width: 80%; text-align: center" border="1"
|+ '''Table 2 – Deceased Organ Donation in India – 2013'''
!State!!Tamil Nadu!!Andhra Pradesh!!Kerala!!Maharashtra!!Delhi!!Gujarat!!Karnataka!!Puducherry!!Total (National)
|-
|'''Donor'''|| ''131'' ||''40''||''35''||''35''||''27''||''25''||''18''||''2''||''313''
|-
|'''* ODR (pmp)'''|| ''1.80'' ||''0.47''||''1.05''||''0.31''||''1.61''||''0.41''||''0.29''||''1.6''||''0.26''
|-
|'''Heart'''|| ''16'' ||''2''||''6''||''0''||''–''||''0''||''1''||''0''||''25''
|-
|'''Lung'''|| ''20'' ||''2''||''0''||''0''||''–''||''0''||''0''||''0''||''22''
|-
|'''Liver'''|| ''118'' ||''34''||''23''||''23''||''23''||''20''||''16''||''0''||''257''
|-
|'''Kidney'''|| ''234'' ||''75''||''59''||''53''||''40''||''54''||''29''||''4''||''548''
|-
|'''Total'''|| '''388''' ||'''113'''||'''88'''||'''76'''||'''63'''||'''74'''||'''46'''||'''4'''||'''852'''
|}
'''* ODR (pmp) – Organ Donation Rate (per million population)'''

In the year 2000 through the efforts of a non-governmental organization called [[MOHAN Foundation]] state of [[Tamil Nadu]] started an organ sharing network between a few hospitals.<ref name="kannan200201">{{cite news | author=Kannan, Ramya | work=[[The Hindu]] | url=http://www.hindu.com/thehindu/2002/01/22/stories/2002012203130300.htm | title=Organ donation gains momentum | date=January 22, 2002 | access-date=March 8, 2014 | location=India | department=Southern States | url-status=dead | archive-date=March 8, 2014 | archive-url=https://web.archive.org/web/20140308233702/http://www.hindu.com/thehindu/2002/01/22/stories/2002012203130300.htm}}</ref><ref name="kannan200302">{{cite news | url=http://www.hindu.com/2003/02/28/stories/2003022809430100.htm | title=High time to streamline organ transplants | work=[[The Hindu]] | date=February 28, 2003 | access-date=March 8, 2014 | author=Kannan, Ramya | location=India | department=Southern States | url-status=dead | archive-date=December 13, 2013 | archive-url=https://web.archive.org/web/20131213165119/http://www.hindu.com/2003/02/28/stories/2003022809430100.htm}}</ref> The MOHAN Foundation also set up similar sharing network in the state of Andhra Pradesh and these two states were at the forefront of deceased donation and transplantation programme for many years.<ref name="raman200207">{{cite news |url=http://www.hindu.com/thehindu/mp/2002/07/25/stories/2002072501030100.htm |title=Living after death |work=[[The Hindu]] |department=Metro Plus Hyderabad |date=July 25, 2002 |access-date=March 8, 2014 |author=Raman, Usha |location=India |url-status=dead |archive-date=November 29, 2010 |archive-url=https://web.archive.org/web/20101129141301/http://hindu.com/thehindu/mp/2002/07/25/stories/2002072501030100.htm}}</ref><ref name="joseph200401">{{cite news | url=http://timesofindia.indiatimes.com/city/hyderabad/Organ-transplantation-help-at-hand/articleshow/447835.cms | title=Organ transplantation help at hand | work=[[The Times of India]] | date=January 28, 2004 | author=Joseph, Lison | department=Hyderabad | url-status=live | archive-url=https://archive.today/20140308002221/http://timesofindia.indiatimes.com/city/hyderabad/Organ-transplantation-help-at-hand/articleshow/447835.cms | archive-date=March 8, 2014 | access-date=October 31, 2016 | df=mdy-all }}</ref> As a result, retrieval of 1,033 organs and tissues were facilitated in these two states.<ref name="mohaninosfigs">{{cite web | url=http://www.mohanfoundation.org/cadaveric-organ-donation-figures.asp?state=Andhra%20Pradesh | title=Cadaveric Organ Donation Figures | publisher=MOHAN Foundation | access-date=March 8, 2014 | at=INOS Figures (2000–2009) | url-status=dead | archive-date=January 2, 2014 | archive-url=https://web.archive.org/web/20140102231124/http://www.mohanfoundation.org/cadaveric-organ-donation-figures.asp?state=Andhra%20Pradesh }}</ref>

Similar sharing networks came up in the states of [[Maharashtra]] and [[Karnataka]]; however, the numbers of deceased donation happening in these states were not sufficient to make much impact. In 2008, the [[Government of Tamil Nadu]] put together government orders laying down procedures and guidelines for deceased organ donation and transplantation in the state.<ref name=mohan08>{{cite web |url=http://www.mohanfoundation.org/organ-donation-transplant-resources/government-orders-organ-donation-%20transplantation-tamil-nadu.asp |title=Government Orders on Organ Donation and Transplantation From Tamil Nadu Health Department |publisher=MOHAN Foundation |access-date=March 8, 2014 |author=Navin, Sumana |year=2008 |url-status=dead |archive-date=December 11, 2013 |archive-url=https://web.archive.org/web/20131211084152/http://www.mohanfoundation.org/organ-donation-transplant-resources/government-orders-organ-donation-%20transplantation-tamil-nadu.asp }}</ref> These brought in almost thirty hospitals in the programme and has resulted in significant increase in the donation rate in the state. With an organ donation rate of 1.15 per million population, Tamil Nadu is the leader in deceased organ donation in the country. The small success of Tamil Nadu model has been possible due to the coming together of both government and private hospitals, non-governmental organizations and the State Health Department. Most of the deceased donation programmes have been developed in southern states of India.<ref name="srinivasan2013">{{cite journal |last1=Srinivasan |first1=S. |title=Has Tamil Nadu turned the tide on the transplant trade? |journal=BMJ |date=April 12, 2013 |volume=346 |pages=f2155 |doi=10.1136/bmj.f2155 |pmid=23585066 |s2cid=31085086 }}</ref> The various such programmes are as follows:
{{columns-list|colwidth=30em|
* Andhra Pradesh – Jeevandan programme
* Karnataka – Zonal Coordination Committee of Karnataka for Transplantation
* Kerala – Mrithasanjeevani – The Kerala Network for Organ Sharing
* Maharashtra – Zonal Transplant Coordination Center in Mumbai
* Rajasthan – Navjeevan – The Rajasthan Network of Organ Sharing
* Tamil Nadu – Cadaver Transplant Programme

}}
In the year 2012 besides Tamil Nadu other southern states too did deceased donation transplants more frequently. An online organ sharing registry for deceased donation and transplantation is used by the states of Tamil Nadu and Kerala. Both these registries have been developed, implemented and maintained by MOHAN Foundation. However. National Organ and Tissue Transplant Organization (NOTTO) is a National level organization set up under Directorate General of Health Services, Ministry of Health and Family Welfare, Government of India and only official organization.

Organ selling is legally banned in Asia. Numerous studies have documented that organ vendors have a poor ''quality of life'' (QOL) following kidney donation. However, a study done by Vemuru reddy ''et al'' shows a significant improvement in Quality of life contrary to the earlier belief.<ref name="PMC3114583">{{cite journal |last1=Vemuru Reddy |first1=SunilK |last2=Guleria |first2=Sandeep |last3=Okechukwu |first3=Okidi |last4=Sagar |first4=Rajesh |last5=Bhowmik |first5=Dipankar |last6=Mahajan |first6=Sandeep |title=Live related donors in India: Their quality of life using world health organization quality of life brief questionnaire |journal=Indian Journal of Urology |date=2011 |volume=27 |issue=1 |pages=25–29 |doi=10.4103/0970-1591.78411 |doi-access=free |pmid=21716885 |pmc=3114583 }}</ref> Live related renal donors have a significant improvement in the QOL following renal donation using the WHO QOL BREF in a study done at the [[All India Institute of Medical Sciences]] from 2006 to 2008. The quality of life of the donor was poor when the graft was lost or the recipient died.<ref name="PMC3114583"/>

In India, there are six types of life saving organs that can be donated to save the life of a patient. These include Kidneys, Liver, Heart, Lungs, Pancreas and Intestine. Off late, uterus transplant has also been started in India. However, uterus is not a life saving organ as per the Transplantation of Human Organs Act (2011).<ref name="The Health">{{cite news |title=Types of Organ Donation In India |url=https://thehealth.today/types-of-organ-donation-in-india/ |work=The Health |date=March 24, 2019 }}</ref>
Recently a scoring system, Seth-Donation of Organs and Tissues (S-DOT) score, has been developed to assess hospitals for best practices in tissue donation and organ donation after brain death.<ref>{{cite journal |last1=Seth |first1=AvnishKumar |last2=Singh |first2=Twinkle |title=Seth-donation of organs and tissues (S-DOT) score: A scoring system for the assessment of hospitals for best practices in organ donation after brain death |journal=Indian Journal of Transplantation |date=2020 |volume=14 |issue=1 |pages=19–24 |id={{Gale|A619446834}} |doi=10.4103/ijot.ijot_49_19 |doi-access=free }}</ref>

===Iran===
Only one country, Iran has eliminated the shortage of transplant organs—and only Iran has a working and legal payment system for organ donation. It is also the only country where organ trade is legal. The way their system works is, if a patient does not have a living relative or who are not assigned an organ from a deceased donor, apply to the nonprofit Dialysis and Transplant Patients Association (Datpa). The association establishes potential donors, those donors are assessed by transplant doctors who are not affiliated with the Datpa association. The government gives a compensation of $1,200 to the donors and aid them a year of limited health-insurance. Additionally, working through Datpa, kidney recipients pay donors between $2,300 and $4,500.<ref name=":0"/> Importantly, it is illegal for the medical and surgical teams involved or any 'middleman' to receive payment.<ref name=":2">{{cite journal |last1=Ghods |first1=Ahad J. |last2=Savaj |first2=Shekoufeh |title=Iranian Model of Paid and Regulated Living-Unrelated Kidney Donation |journal=Clinical Journal of the American Society of Nephrology |date=November 2006 |volume=1 |issue=6 |pages=1136–1145 |doi=10.2215/CJN.00700206 |pmid=17699338 }}</ref> Charity donations are made to those donors whose recipients are unable to pay. The Iranian system began in 1988 and eliminated the shortage of kidneys by 1999. Within the first year of the establishment of this system, the number of transplants had almost doubled; nearly four-fifths were from living unrelated sources.<ref name=":2"/> Nobel Laureate economist [[Gary Becker]] and Julio Elias estimated that a payment of $15,000 for living donors would alleviate the shortage of kidneys in the U.S.<ref name=":0"/>

===Israel===
{{see also|Organ transplantation in Israel}}
Since 2008, signing an organ donor card in Israel has provided a potential medical benefit to the signer. If two patients require an organ donation and have the same medical need, preference will be given to the one that had signed an organ donation card. (This policy was nicknamed "Don't give, don't get".) Organ donation in Israel increased after 2008.{{citation needed|date=February 2024}}

===Japan===
{{see also|Organ transplantation in Japan}}

The rate of organ donation in Japan is significantly lower than in Western countries.<ref name=Wicks>{{cite journal |last1=Wicks |first1=Mona Newsome |date=April 25, 2000 |title=Brain Death and Transplantation: The Japanese |journal=Medscape Transplantation |volume=1 |issue=1 |url=https://www.medscape.com/viewarticle/408769 }}</ref> This is attributed to cultural reasons, some distrust of [[western medicine]], and a controversial [[Organ transplantation in Japan|organ transplantation in 1968]] that provoked a ban on cadaveric organ donation that would last thirty years.<ref name=Wicks/> Organ donation in Japan is regulated by a 1997 organ transplant law, which defines "[[brain death]]" and legalized organ procurement from brain dead donors.

===Netherlands===
The Netherlands sends everyone living in the country a postcard when they turn 18 (and everyone living in the country when the 2020 law came into effect), and one reminder if they do not reply. They may choose to donate, not to donate, to delegate the choice to family, or to name a specific person. If they do not reply to either notice, they are considered a donor by default.<ref>{{Cite web|url=https://www.government.nl/topics/organ-tissue-donation/new-donor-act-active-donor-registration|title=The new Donor Act (active donor registration) – Organ and tissue donation – Government.nl|first=Welzijn en Sport|last=Ministerie van Volksgezondheid|date=June 14, 2018|website=www.government.nl}}</ref> A family cannot object unless there is reason to show the person would not have wanted to donate. If a person cannot be found in the national donor registry, because they are travelling from another country or because they are undocumented, their organs are not harvested without family consent. Organs are not harvested from people who die an [[unnatural death]] without the approval of the local attorney general.

===New Zealand===
[[File:Belisaire demandant l'aumone Jacques-Louis David.jpg|thumb|Altruism]]
New Zealand law allows live donors to participate in [[Altruism|altruistic]] organ donation only. In the five years to 2018, there were 16 cases of liver donation by live donors and 381 cases of kidney donation by live donors.<ref name=":5">{{Cite web|url=https://www.donor.co.nz/facts-and-myths/statistics/|title=Statistics|website=www.donor.co.nz|access-date=December 4, 2019}}</ref> New Zealand has low rates of live donation, which could be due to the fact that it is illegal to pay someone for their organs. The Human Tissue Act 2008 states that trading in human tissue is prohibited, and is punishable by a fine of up to $50,000 or a prison term of up to 1 year.<ref>{{Cite web|title = Human Tissue Act 2008|url = http://www.legislation.govt.nz/act/public/2008/0028/latest/DLM1154238.html|access-date=August 10, 2015 |publisher = New Zealand Legislature|date = July 1, 2013|id = Public Act 2008 No 28}}</ref> The Compensation for Live Organ Donors Act 2016, which came into force in December 2017, allows live organ donors to be compensated for lost income for up to 12 weeks post-donation.<ref>{{Cite web|url=https://www.health.govt.nz/our-work/hospitals-and-specialist-care/organ-donation-and-transplantation/compensation-live-organ-donors|title=Compensation for Live Organ Donors|website=Ministry of Health NZ|access-date=December 4, 2019}}</ref>

New Zealand law also allows for organ donation from deceased individuals. In the five years to 2018, organs were taken from 295 deceased individuals.<ref name=":5"/> Everyone who applies for a driver's licence in New Zealand indicates whether or not they wish to be a donor if they die in circumstances that would allow for donation.<ref name="NZTA">{{Cite web|url = http://www.nzta.govt.nz/driver-licences/getting-a-licence/organ-and-tissue-donation/|title = Organ and tissue donation|website = Getting a license|publisher = NZ Transport Agency}}</ref> The question is required to be answered for the application to be processed, meaning that the individual must answer yes or no, and does not have the option of leaving it unanswered.<ref name=NZTA/> However, the answer given on the drivers license does not constitute [[informed consent]], because at the time of drivers license application not all individuals are equipped to make an informed decision regarding whether to be a donor, and it is therefore not the deciding factor in whether donation is carried out or not.<ref name=NZTA/> It is there to simply give indication of the person's wishes.<ref name=NZTA/> Family must agree to the procedure for donation to take place.<ref name=NZTA/><ref>{{Cite web|url = http://njr.cdhb.health.nz/nephrology/kidney-donation.htm|title = Kidney Donation|date = October 2011|website = Nephrology Department, Christchurch Hospital, New Zealand|publisher = Canterbury District Health Board |url-status=dead |archive-url=https://web.archive.org/web/20141129223137/http://njr.cdhb.health.nz/nephrology/kidney-donation.htm |archive-date=November 29, 2014}}</ref>

A 2006 bill proposed setting up an organ donation register where people can give informed consent to organ donations and clearly state their legally binding wishes.<ref>{{Cite web |url=http://www.parliament.nz/en-nz/pb/legislation/bills/00DBHOH_BILL7223_1/human-tissue-organ-donation-amendment-bill |title=New Zealand Parliament "Human Tissue (Organ Donation) Amendment Bill"|date=November 7, 2007 }}</ref> However, the bill did not pass, and there was condemnation of the bill from some doctors, who said that even if a person had given express consent for organ donation to take place, they would not carry out the procedure in the presence of any disagreement from grieving family members.<ref>{{cite news |last1=Johnston |first1=Martin |title=Doctors oppose organ donor bill |url=https://www.nzherald.co.nz/nz/doctors-oppose-organ-donor-bill/SB4LATA7K652AENU5PFVLQ26CA/ |work=[[The New Zealand Herald]] |date=February 18, 2024 |language=en-NZ }}</ref>

The indigenous population of New Zealand also have strong views regarding organ donation. Many [[Māori people|Maori]] people believe organ donation is morally unacceptable due to the cultural need for a dead body to remain fully intact.<ref name=MOAL>{{cite web |publisher=Mauri Ora Associates Limited |title=Māori Pacific Attitudes Towards Transplantation: Professional Perspectives |url=https://www.tewhatuora.govt.nz/assets/About-us/Who-we-are/Expert-groups/National-Renal-Advisory-Board/Papers-and-reports/Dialysis/Maori-Pacific-Attitudes-Towards-Transplantation-PDF-945-KB.pdf }}</ref> However, because there is not a universally recognised cultural authority, no one view on organ donation is universally accepted in the Maori population.<ref name=MOAL/> They are, however, less likely to accept a kidney transplant than other New Zealanders, despite being overrepresented in the population receiving dialysis.<ref name=MOAL/>

===South Korea===
In [[South Korea]], the 2006 provision of the Organ Transplant Act introduced a monetary incentive equivalent to US$4,500 to the surviving family of brain-death donors; the reward is intended as consolation and compensation for funeral expenses and hospital fees.<ref name="Pham" /><ref name="Lee Kim">{{cite journal |last1=Lee |first1=S.D. |last2=Kim |first2=J.H. |title=Changes in the Organ Procurement System in South Korea: Effects on Brain-Dead Donor Numbers |journal=Transplantation Proceedings |date=November 2009 |volume=41 |issue=9 |pages=3551–3555 |doi=10.1016/j.transproceed.2009.06.210 |pmid=19917342 }}</ref>

===Sri Lanka===
Organ donation in Sri Lanka was ratified by the Human Tissue Transplantation Act No. 48 of 1987. [[Sri Lanka Eye Donation Society]], a non-governmental organization established in 1961 has provided over 60,000 corneas for [[corneal transplantation]], for patients in 57 countries. It is one of the major suppliers of human eyes to the world, with a supply of approximately 3,000 corneas per year.<ref name="associatedpr">{{cite news | url=https://www.foxnews.com/health/sri-lanka-donates-eyes-to-the-world | title=Sri Lanka donates eyes to the world | agency=Associated Press | work=[[Foxnews.com]] | date=January 23, 2012 | access-date=March 9, 2014 | url-status=live | archive-date=January 23, 2014 | archive-url=https://web.archive.org/web/20140123131649/http://www.foxnews.com/health/2012/01/23/sri-lanka-donates-eyes-to-world/}}</ref>

===United Kingdom===
====Wales====
[[File:Vaughan Gething AM addresses the Kidney Research UK Annual Fellows day.webm|thumb|[[Vaughan Gething]], [[Welsh Government]] Health Minister, addresses the [[Kidney Research UK]] Annual Fellows Day; 2017]]
Since December 2015, [[Human Transplantation (Wales) Act 2013]] passed by the [[Welsh Government]] has enabled an opt-out organ donation register, the first country in the UK to do so. The legislation is 'deemed consent', whereby all citizens are considered to have no objection to becoming a donor, unless they have opted out on this register.<ref>{{cite web |title=Organ donation law in Wales |url=https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-wales/ |website=NHS Wales |access-date=January 31, 2021}}</ref>

====England====
[[File:NHS Organ Donor Card.png|thumb|NHS England Organ Donor Card]]
The [[Organ Donation (Deemed Consent) Act 2019]] established opt-out organ donation in England, also known as Max and Keira's law, when came into effect in May 2020. It means adults in England will be automatically be considered potential donors unless they chose to opt out or are excluded.<ref>{{Cite web|date=March 15, 2019|title=Opt-out organ donation passed into law|url=https://nursingnotes.co.uk/news/workforce/opt-out-organ-donation-passed-into-law/|access-date=June 16, 2019|website=NursingNotes}}</ref>

==== Scotland ====
The [[Human Tissue (Authorisation) (Scotland) Act 2019]] established opt-out organ donation in Scotland in March 2021.<ref name=":6" /><ref>{{cite news |last1=Hutchison |first1=Caitlin |title=Scotland's organ donation law changed today—here's what it means for you |url=https://www.heraldscotland.com/news/19187565.opt-out-organ-donation-scotland-everything-need-know-scottish-law-changing/ |access-date=April 14, 2021 |work=HeraldScotland |publisher=Herald and Times Group |agency=Newsquest Media Group}}</ref>

==== Northern Ireland ====
The [[Organ and Tissue Donation (Deemed Consent) Act (Northern Ireland) 2022]] established opt-out organ donation in 2023.<ref name=":7" />

====Dependencies====
In Jersey, the Capacity and Self-Determination (Jersey) Law 2016 established an opt-out register on July 1, 2019.<ref>{{Cite news|url=https://www.bbc.com/news/world-europe-jersey-48763861|title=Opt-out organ donation comes into force|date=July 1, 2019|access-date=October 7, 2019}}</ref><ref>{{Cite web|url=https://www.itv.com/news/channel/2019-07-01/jerseys-opt-out-organ-donation-law-comes-into-effect-today/|title=Jersey's opt-out organ donation law comes into effect today|website=ITV News|date=July 2019|access-date=October 7, 2019}}</ref>

in Guernsey, the Human Tissue and Transplantation (Bailiwick of Guernsey) Law, 2020 established opt-out organ donation in 2023.<ref>{{Cite news |date=January 1, 2023 |title=Guernsey switches to 'opt-out' organ donation system |url=https://www.bbc.com/news/world-europe-guernsey-64139761 |access-date=2024-10-10 |work=[[BBC News]] |publisher=British Broadcasting Corporation}}</ref>

In the Isle of Man, the Human Tissue and Organ Donation Act 2021 has provisions to establish opt-out organ donation, which have not been enacted.<ref>{{Cite news |last=Brahde |first=Rebecca |date=February 5, 2024 |title=No timeline for huge change in organ donation rules in the Isle of Man |url=https://www.iomtoday.co.im/news/no-timeline-for-huge-change-in-organ-donation-rules-in-the-isle-of-man-663929 |access-date=2024-10-10 |work=Isle of Man Today}}</ref>

===United States===
Over 121,000 people in need of an organ are on the U.S. government waiting list.<ref>{{cite web|title=Organ Procurement and Transplantation Network|url=http://optn.transplant.hrsa.gov/converge/data/|publisher=U.S. Department of Health & Human Services|access-date=October 11, 2015|url-status=dead|archive-url=https://web.archive.org/web/20151013182114/http://optn.transplant.hrsa.gov/converge/data/|archive-date=October 13, 2015}}</ref> This crisis within the United States is growing rapidly because on average there are only 30,000 transplants performed each year. More than 8,000 people die each year from lack of a donor organ, an average of 22 people a day.<ref>{{Cite web|url=https://organdonor.gov/statistics-stories/statistics.html|title=Organ Donation Statistics: Why be an Organ Donor? {{!}} organdonor.gov|website=organdonor.gov|access-date=June 22, 2017}}</ref><ref name="Dai 2020 622–641"/> Between the years 1988 and 2006 the number of transplants doubled, but the number of patients waiting for an organ grew six times as large.<ref>{{cite web|title=Need continues to grow|url=http://optn.transplant.hrsa.gov/converge/data/|publisher=U.S. Department of Health & Human Services|access-date=October 11, 2015|url-status=dead|archive-url=https://web.archive.org/web/20151013182114/http://optn.transplant.hrsa.gov/converge/data/|archive-date=October 13, 2015}}</ref>

In the past presumed consent was urged to try to decrease the need for organs. The [[Uniform Anatomical Gift Act]] of 1987 was adopted in several states, and allowed medical examiners to determine if organs and tissues of cadavers could be donated. By the 1980s, several states adopted different laws that allowed only certain tissues or organs to be retrieved and donated, some allowed all, and some did not allow any without consent of the family. In 2006 when the UAGA was revised, the idea of presumed consent was abandoned. In the United States today, organ donation is done only with consent of the family or donator themselves.<ref>{{cite journal |last1=Orentlicher |first1=David |title=Presumed Consent to Organ Donation: Its Rise and Fall in the United States |journal=Rutgers Law Review |date=Winter 2009 |volume=61 |issue=2 |pages=295–332 |hdl=10822/1026142 |ssrn=1207862 }}</ref>

In most states, residents can register to become organ donors through the Department of Motor Vehicles.  The driver's license will serve as a legal donor card for the registered donor.  U.S. Residents may also choose to register as organ, eye, and tissue donors through a national registry maintained by Donate Life America.  The national website is RegisterMe.org The national registry allows residents to create a login, password, and edit their donation choice by organ.  The most common transplants consists of only six (6) organs:  heart, lungs, liver, kidney, pancreas, and small intestines.  One healthy donor can potentially save up to eight (8) lives through transplants, using the two lungs and two kidneys separately.  The most needed organ for transplants overall are kidneys, due to the high rate of hypertension (HTN) or high blood pressure and diabetes which can lead to end-stage renal disease.

According to economist Alex Tabarrok, the shortage of organs has increased the use of so-called expanded criteria organs, or organs that used to be considered unsuitable for transplant.<ref name=":0"/> Five patients that received kidney transplants at the [[University of Maryland School of Medicine]] developed cancerous or benign tumors which had to be removed. The head surgeon, Dr. Michael Phelan, explained that "the ongoing shortage of organs from deceased donors, and the high risk of dying while waiting for a transplant, prompted five donors and recipients to push ahead with the surgery."<ref name=":0">{{Cite news|url = https://www.wsj.com/articles/SB10001424052748703481004574646233272990474|title = The Meat Market|last = Tabarrok|first = Alex|date = January 8, 2010|work = [[Wall Str. J.|The Wall Street Journal]]|author-link = Alex Tabarrok|department = The Saturday Essay}}</ref> Several organizations such as the [[American Kidney Fund]] are pushing for opt-out organ donation in the United States.<ref>{{cite magazine|last1=Carney|first1=Scott|title=The Case for Mandatory Organ Donation|url=http://archive.wired.com/medtech/health/news/2007/05/india_transplants_donorpolicy|magazine=Wired|access-date=February 13, 2015|date=May 8, 2007}}</ref>

====Donor Leave Laws====
In addition to their sick and annual leave, federal executive agency employees are entitled to 30 days paid leave for organ donation.<ref name="Fed Organ Leave Law">{{cite web|title=Fact Sheet: Bone Marrow or Organ Donor Leave|url=https://www.opm.gov/policy-data-oversight/pay-leave/leave-administration/fact-sheets/bone-marrow-or-organ-donor-leave/|website=Pay & Leave: Leave Administration|publisher=United States Office of Personnel Management|access-date=October 8, 2016}}</ref> Thirty-two states (excluding only [[Alabama]], [[Connecticut]], Florida, [[Kentucky]], [[Maine]], [[Michigan]], [[Montana]], [[Nebraska]], [[Nevada]], [[New Hampshire]], [[New Jersey]], [[North Carolina]], [[Pennsylvania]], [[Rhode Island]], [[South Dakota]], [[Tennessee]], [[Vermont]], and [[Wyoming]]) and the [[District of Columbia]] also offer paid leave for state employees.<ref name="Leave Laws Fact Sheet">{{cite web|title=Donor Leave Laws and Tax Deductions/Credits for Living Donors|url=https://www.kidney.org/sites/default/files/LDTaxDed_Leave.pdf|website=Donor Leave Laws and Tax Deductions/Credits for Living Donors|publisher=National Kidney Foundation|access-date=October 8, 2016|archive-url=https://web.archive.org/web/20161011122058/https://www.kidney.org/sites/default/files/LDTaxDed_Leave.pdf|archive-date=October 11, 2016|url-status=dead}}</ref> Five states (California, Hawaii, [[Louisiana]], [[Minnesota]], and [[Oregon]]) require certain private employers to provide paid leave for employees for organ or bone marrow donation, and seven others ([[Arkansas]], Connecticut, Maine, Nebraska, New York, [[South Carolina]], and [[West Virginia]]) either require employers to provide unpaid leave, or encourage employers to provide leave, for organ or bone marrow donation.<ref name="Leave Laws Fact Sheet"/>

A bill in the US House of Representatives, the Living Donor Protection Act (introduced in 2016, then reintroduced in 2017<ref name=LDP17>{{cite web| url= https://www.myast.org/living-donor-protection-act-2017-reintroduced| website= myast.org| publisher= American Society of Transplantation| title= The Living Donor Protection Act of 2017 Reintroduced| date= March 1, 2017| access-date= March 17, 2018}}</ref>), would amend the [[Family and Medical Leave Act of 1993]] to provide leave under the act for an organ donor. If successful, this new law would permit "eligible employee" organ donors to receive up to 12 work weeks of leave in a 12-month period.<ref name="HR4616">{{cite web|title= H.R.4616 – Living Donor Protection Act of 2016|url=https://www.congress.gov/bill/114th-congress/house-bill/4616 |website= Congress.gov |access-date=October 8, 2016|date=February 26, 2016 }}</ref><ref>{{cite web| title= H.R.1270 – Living Donor Protection Act of 2017 – 115th Congress (2017–2018)| url= https://www.congress.gov/bill/115th-congress/house-bill/1270| website= Congress.gov |access-date= March 17, 2018| date= March 17, 2017}}</ref>

====Tax incentives====
Nineteen US states and the [[District of Columbia]] provide tax incentives for organ donation.<ref name="Leave Laws Fact Sheet"/> The most generous state tax incentive is [[Utah]]'s tax credit, which covers up to $10,000 of unreimbursed expenses (travel, lodging, lost wages, and medical expenses) associated with organ or tissue donation.<ref name="Leave Laws Fact Sheet"/> [[Idaho]] (up to $5,000 of unreimbursed expenses) and [[Louisiana]] (up to $7,500 of 72% of unreimbursed expenses) also provide donor tax credits.<ref name="Leave Laws Fact Sheet"/> [[Arkansas]], the [[District of Columbia]], [[Louisiana]] and [[Pennsylvania]] provide tax credits to employers for wages paid to employees on leave for organ donation.<ref name="Leave Laws Fact Sheet"/> Thirteen states ([[Arkansas]], [[Georgia (U.S. state)|Georgia]], [[Iowa]], [[Massachusetts]], [[Mississippi]], [[New Mexico]], New York, [[North Dakota]], [[Ohio]], [[Oklahoma]], [[Rhode Island]] and [[Wisconsin]]) have a tax deduction for up to $10,000 of unreimbursed costs, and [[Kansas]] and [[Virginia]] offer a tax deduction for up to $5,000 of unreimbursed costs.<ref name="Leave Laws Fact Sheet"/>

States have focused their tax incentives on unreimbursed costs associated with organ donation to ensure compliance with the [[National Organ Transplant Act of 1984]].<ref name="Larger Sacrifice">{{cite journal|last1=Molen|first1=M. Lane|title=Recognizing the Larger Sacrifice: Easing the Burdens Borne by Living Organ Donors through Federal Tax Deductions|journal=Brigham Young University Journal of Public Law|date=May 1, 2007|volume=21|issue=2|page=459|url=http://digitalcommons.law.byu.edu/cgi/viewcontent.cgi?article=1391&context=jpl|access-date=October 8, 2016}}</ref> NOTA prohibits, "any person to knowingly acquire, receive, or otherwise transfer any human organ for valuable consideration for use in human transplantation."<ref name="NOTA">{{cite web|title=42 U.S. Code § 274e – Prohibition of organ purchases|url=https://www.law.cornell.edu/uscode/text/42/274e|website=Legal Information Institute|publisher=Cornell University Law School|access-date=October 8, 2016}}</ref> However, NOTA exempts, "the expenses of travel, housing, and lost wages incurred by the donor of a human organ in connection with the donation of the organ," from its definition of "valuable consideration".<ref name="NOTA"/>

While offering income tax deductions has been the preferred method of providing tax incentives, some commentators have expressed concern that these incentives provide disproportionate benefits to wealthier donors.<ref name="CaseAgainstTaxIncentives">{{cite journal |last1=Milot |first1=Lisa |title=The Case Against Tax Incentives for Organ Transfers |journal=Willamette Law Review |date=2008 |volume=45 |pages=67–90 |url=https://willamette.edu/law/resources/journals/review/pdf/volume-45/wlr45-1-milot-11-18-08.pdf }}</ref> Tax credits, on the other hand, are perceived as more equitable since the after tax benefit of the incentive is not tied to the marginal tax rate of the donor.<ref name="CaseAgainstTaxIncentives"/>

Additional tax favored approaches have been proposed for organ donation, including providing: tax credits to the families of deceased donors (seeking to encourage consent), refundable tax credits (similar to the earned income credit) to provide greater tax equity among potential donors, and charitable deductions for the donation of blood or organs.<ref name="Lifeline">{{cite journal |last1=Clamon |first1=Joseph B. |title=Tax policy as a lifeline: encouraging blood and organ donation through tax credits |journal=Annals of Health Law |date=2008 |volume=17 |issue=1 |pages=67–99 |pmid=18365650 |url=https://lawecommons.luc.edu/annals/vol17/iss1/5/ }}</ref>

====Other financial incentives====
As stated above, under the [[National Organ Transplant Act of 1984]], granting monetary incentives for organ donation is illegal in the United States.<ref name="National Organ Transplant Act">{{citation|title=National Organ Transplant Act |publisher=US Code|ref=42 US Code 274e.}}</ref> However, there has been some discussion about providing fixed payment for potential live donors. In 1988, regulated paid organ donation was instituted in [[Iran]] and, as a result, the renal transplant waiting list was eliminated. Critics of paid organ donation argue that the poor and vulnerable become susceptible to transplant tourism. Travel for transplantation becomes transplant tourism if the movement of organs, donors, recipients or transplant professionals occurs across borders and involves organ trafficking or transplant commercialism. Poor and underserved populations in underdeveloped countries are especially vulnerable to the negative consequences of transplant tourism because they have become a major source of organs for the 'transplant tourists' that can afford to travel and purchase organs.<ref name="Br J Anaesth.">{{cite journal |last1=Rudge |first1=C. |last2=Matesanz |first2=R. |last3=Delmonico |first3=F.L. |last4=Chapman |first4=J. |title=International practices of organ donation |journal=British Journal of Anaesthesia |date=January 2012 |volume=108 |pages=i48–i55 |doi=10.1093/bja/aer399 |pmid=22194431 |doi-access=free }}</ref>

In 1994 a law was passed in Pennsylvania which proposed to pay $300 for room and board and $3,000 for funeral expenses to an organ donor's family. Developing the program was an eight-year process; it is the first of its kind. Procurement directors and surgeons across the nation await the outcomes of Pennsylvania's program.<ref>{{cite web|last1=Wiggins|first1=Ovetta|title=Pa. organ donors get $300 boost It pays for food or lodging for them or their family. A bigger plan's rejection rankles some |url=http://articles.philly.com/2002-05-27/news/25345733_1_organ-donation-life-donor-program-organ-transplants|archive-url=https://web.archive.org/web/20150402182503/http://articles.philly.com/2002-05-27/news/25345733_1_organ-donation-life-donor-program-organ-transplants|url-status=dead|archive-date=April 2, 2015|website=Philly.com|publisher=Philadelphia Media Network|access-date=February 28, 2015}}</ref> There have been at least nineteen families that have signed up for the benefit. Due to investigation of the program, however, there has been some concern whether the money collected is being used to assist families.<ref name="PennLittle">{{cite web|last1=Conte|first1=Andrew|last2=Fabregas|first2=Luis|title=Drivers' $1 donation yields little for Pennsylvania organ donors and their families|url=http://triblive.com/news/allegheny/4540138-74/organ-donors-donor|website=Trib Live|publisher=Trib Total Media LLC|access-date=October 8, 2016}}</ref> Nevertheless, funeral aids to induce post-mortem organ donation have also received support from experts and the general public, as the incentives present more ethical values, such as honoring the deceased donor or preserving voluntariness, and potentially increase donation willingness.<ref name="Arnold et al">{{cite journal |last1=Arnold |first1=Robert |last2=Bartlett |first2=Steven |last3=Bernat |first3=James |last4=Colonna |first4=John |last5=Dafoe |first5=Donald |last6=Dubler |first6=Nancy |last7=Gruber |first7=Scott |last8=Kahn |first8=Jeffrey |last9=Luskin |first9=Richard |last10=Nathan |first10=Howard |last11=Orloff |first11=Susan |last12=Prottas |first12=Jeffrey |last13=Shapiro |first13=Robyn |last14=Ricordi |first14=Camillo |last15=Youngner |first15=Stuart |last16=Delmonico |first16=Francis L. |title=Financial incentives for cadaver organ donation: an ethical reappraisal1 |journal=Transplantation |date=April 2002 |volume=73 |issue=8 |pages=1361–1367 |doi=10.1097/00007890-200204270-00034 |pmid=11981440 |s2cid=29823737 |doi-access=free }}</ref><ref name="Pham">{{cite journal |last1=Pham |first1=Vinh |title=Cash, Funeral Benefits or Nothing at All: How to Incentivize Family Consent for Organ Donation|url=https://mpra.ub.uni-muenchen.de/111047/12/MPRA_paper_111047.pdf |journal=Review of Behavioral Economics |date=2021 |volume=8 |issue=2 |pages=147–192 |doi=10.1561/105.00000136 |s2cid=237705443 }}</ref>

Some organizations, such as the National Kidney Foundation, oppose financial incentives associated with organ donation claiming, "Offering direct or indirect economic benefits in exchange for organ donation is inconsistent with our values as a society."<ref name="KidneyFoundOppose">{{cite web|title=Financial Incentives for Organ Donation|url=https://www.kidney.org/news/newsroom/positionpaper03|website=National Kidney Foundation|access-date=October 8, 2016|date=August 12, 2014}}</ref> One argument is it will disproportionately affect the poor.<ref>{{cite journal|last1=Krauthammer|first1=Charles|title=Yes, Let's Pay for Organs|url=http://content.time.com/time/magazine/article/0,9171,990984,00.html|journal=Time|volume=153|issue=19|pages=100|access-date=February 28, 2015|date=May 17, 1999|pmid=11645351}}</ref> The $300–3,000 reward may act as an incentive for poorer individuals, as opposed to the wealthy who may not find the offered incentives significant. The National Kidney Foundation has noted that financial incentives, such as this Pennsylvania statute, diminish human dignity.<ref name="KidneyFoundOppose"/>