LONDON (NYTIMES) - Britain took a crucial step on Friday (Feb 23) towards making all adults presumed organ donors unless they say otherwise, which would add the country to a growing list of those that have adopted the policy to address a chronic shortage for transplants.
The House of Commons, on a sparsely attended voice vote, gave unanimous approval to send an organ donor bill to committee, where a final version would be hammered out.
Though it still could face procedural obstacles, it has the support of a rare alliance of the Conservative government, the leadership of the opposition Labour Party, and the British medical establishment, indicating that chances of passage are good.
"I've seldom seen such a unanimous range of support," said Geoffrey Robinson, the Labour lawmaker who sponsored the bill and who was one of dozens from both major parties who spoke in favour of it on Friday. "This will save lives."
The change would apply in England. The Scottish Parliament is also considering moving to an opt-out system, while Northern Ireland requires explicit consent. Wales has had presumed consent to organ donation since 2015.
Dozens of countries have "presumed consent" laws, in which people who do not want their organs to be used must take formal steps to opt out of donation. Though some of those rules have been in place for decades, most have been adopted in recent years; an opt-out system took effect in France last year, and the Dutch Parliament approved one this month.
In the United States, to be organ donors, people must fill out forms or join an online registry, or their families must give approval; a few states have considered opt-out bills, but none have adopted them.
Though public opinion surveys show that a vast majority of people in developed countries favor organ donation, far fewer sign up as donors, and thousands of people around the world die every year while waiting for kidneys, hearts, livers, lungs and other tissue to become available.
The European countries with the highest donation rates - Belgium, Portugal and Spain - have long-standing presumed consent laws. But in some countries, like Sweden, such laws have not produced high donation rates.
In 2008, Gordon Brown, then the prime minister, called for a presumed consent law in Britain, a measure that the British Medical Association has advocated for years. But the plan was doomed by criticism from a government task force and by some religious leaders; in particular, some Orthodox Jewish authorities took the position that standard organ harvesting practices violated Jewish law, which prohibits desecrating the body.
Since then, surveys have shown rising public sentiment in favour of donation, driven partly by highly publicised cases of people who were forced to wait for organs. With the cooperation of rabbinical authorities, Israel has loosened its restrictions on organ transplant.
Last fall, Prime Minister Theresa May said Parliament should change to an opt-out system, and the government has invited public comment on the issue through March 6.
Several lawmakers from both major parties said on Friday that the success of a new law would depend largely on specifics that had yet to be worked out. Designing the program poorly could backfire, they said, making people distrust the system and increasing the rate of refusals.
Noting Mr Brown's experience and the uneven record of the laws in other countries, lawmakers advocated a "soft" system, in which families could refuse donation even if their dead relatives had not opted out.
Most countries with opt-out laws have gone that route, but a few, like Austria and Singapore, have "hard" opt outs, in which the family's wishes can be dismissed.
"There can be no question of the state taking control of organs, and that's why the ability to opt out is central to this bill, and it has to be made relatively easy," said Jackie Doyle-Price, a Conservative health minister.
"It's also central to this that the issue of family consent is respected."