Registering your organ donation decision is one of the most straightforward acts of end-of-life planning you can complete — and one of the most impactful. A single donor can save up to nine lives and improve the lives of many more through tissue donation.
As of 31 March 2025, 8,096 people in the UK were actively waiting for a transplant, including 276 children — the highest number ever recorded. More than 25 million people are already on the NHS Organ Donor Register, but missed opportunities still occur every year because families are left uncertain about what their loved one wanted.
This guide covers how the opt-out system works across the UK, how to join or update the NHS Organ Donor Register, what can be donated, who is eligible, what happens to the body, religious considerations, and — critically — why telling your family matters just as much as registering.
How does organ donation work in the UK?
The UK uses an opt-out system in all four nations, meaning adults are considered willing to donate their organs after death unless they have registered a decision not to do so (or fall into an excluded group).
This system is often called “deemed consent” or “presumed consent.” If you have not registered any decision and you die in circumstances where donation is possible, it is assumed you agree. You can override this at any time by registering an opt-out on the NHS Organ Donor Register.
Each nation introduced the opt-out system at a different time:
| Nation | System | Law name | In effect from |
|---|---|---|---|
| Wales | Opt-out (deemed consent) | Human Transplantation (Wales) Act 2013 | December 2015 |
| England | Opt-out (deemed consent) | Organ Donation (Deemed Consent) Act 2019 – "Max and Keira's Law" | 20 May 2020 |
| Scotland | Opt-out (deemed authorisation) | Human Tissue (Authorisation) (Scotland) Act 2019 | March 2021 |
| Northern Ireland | Opt-out (deemed consent) | Organ and Tissue Donation (Deemed Consent) Act (Northern Ireland) 2022 – "Dáithí's Law" | 1 June 2023 |
Sources: NHS Organ Donation – UK laws, organdonationni.info. Last verified: April 2026.
What “deemed consent” means in practice
Deemed consent does not override your right to choose. You can register a decision to donate all organs, specific organs only, or no organs at all. Whatever you register is what the NHS follows. If you have not registered anything, the opt-out law applies and you are considered willing to donate.
Who is excluded from the opt-out system?
Certain groups are automatically excluded and are not subject to deemed consent:
- People under 18 (in England – under-18s can register their own decision from age 12, but parents or guardians decide if no decision is registered)
- People who lack the mental capacity to understand the arrangements
- People who have lived in England for less than 12 months before death
- People who are not living in England voluntarily
- People who have appointed a nominated representative to decide on their behalf
Similar exclusions apply in Wales, Scotland, and Northern Ireland. In all nations, parents or guardians can register a decision on behalf of a child of any age.
How to join the NHS Organ Donor Register
Registering takes about two minutes at organdonation.nhs.uk. You can also register via the NHS App on your phone.
When you register, you can specify:
- Donate all organs and tissues
- Donate specific organs only (for example, kidneys and corneas, but not heart)
- Donate no organs (registering an opt-out)
- Nominate a representative to make the decision after you die
You can change your decision at any time — there is no limit to how many times you can update your registration.
What you can specify on the register
| Category | What you can include or exclude |
|---|---|
| Organs | Heart, lungs, liver, kidneys, pancreas, small bowel – choose all or specific ones |
| Tissues | Corneas, skin, bone, heart valves, tendons – can be included or excluded separately |
| Nominated representative | A person authorised to make the donation decision on your behalf |
Source: NHS Organ Donation – what can you donate. Last verified: April 2026.
If you hold a driving licence, you can also indicate your donor status there — though the NHS Organ Donor Register is the definitive record that medical teams use.
What can be donated?
Organs: Six main organs can be donated after death: heart, lungs, liver, kidneys, pancreas, and small bowel. Kidneys are the most commonly needed organ — nearly 4,500 people were waiting for one as of March 2025.
Tissues: Tissues can be donated in a wider range of circumstances because they can often be processed and stored for longer. These include corneas (which can restore sight for two people per donation), skin used for burns patients, bone and tendons used in orthopaedic surgery, and heart valves used in cardiac surgery.
Hands, face, and limbs: These transplants do take place but fall outside the standard donation register. They occur only as part of specialist programmes and require explicit family agreement beyond the opt-out consent framework.
Source: NHS Organ Donation – what can you donate. Last verified: April 2026.
Who can donate?
There is no upper age limit for organ donation. The oldest organ donors in the UK have been in their 80s and 90s. Every case is assessed individually by specialist clinical staff at the time of death — age alone is not a reason to exclude someone.
Having a medical condition does not automatically prevent you from donating. People with certain past cancers may be eligible after a period of clear treatment. Smokers can donate. People who cannot give blood can still donate organs. Specialist healthcare professionals assess suitability case by case at the time of death.
The one clear exception: active cancer at the time of death typically prevents organ donation, though it may be possible for some cancer types after three years of successful treatment.
Source: NHS Organ Donation – who can donate. Last verified: April 2026.
Can your family override your decision?
This is the most important thing to understand about the opt-out system. Although deemed consent is now law, the NHS always consults the family before proceeding. In practice, if a family strongly objects to donation, transplant teams will not proceed — regardless of what the law says or what the person registered.
This is a clinical and ethical reality, not a legal override. It means your registered decision is necessary — but not sufficient on its own.
Research from NHS Blood and Transplant shows:
- When a family knows their loved one wanted to donate, more than 92% support the decision
- When the family does not know, support drops to around 51%
- Each year, hundreds of potential transplants are missed because families are uncertain
The conversation does not need to be long or difficult. Saying “I’ve registered as a donor — I want you to support that if the time comes” is enough.
Source: NHS Organ Donation – talk to your loved ones. Last verified: April 2026.
What happens to the body?
Organ donation surgery is carried out with the same care and respect as any other surgical procedure. A specialist surgical team removes the donated organs, and the incisions are closed and dressed in the same way as any operation.
Donation does not delay funeral arrangements, and it does not prevent an open casket funeral. After donation, the body is returned to the family in the same way as any hospital death where donation has not taken place. Other than a surgical dressing, the appearance of the body is not altered by donation.
Source: NHS Organ Donation – get the facts. Last verified: April 2026.
Organ donation and faith
Most major faiths in the UK either actively support organ donation or leave the decision to the individual:
- Christianity: Supported as an expression of love and service. The Methodist Church formally endorses it.
- Islam: Permitted by UK fatawa (religious edicts), including rulings from the Muslim Law Council (1995) and Mufti Mohammed Zubair Butt (2019). Family wishes are always respected.
- Judaism: Supported, with the principle of pikuach nefesh (saving a life) taking priority. Jewish families may wish to consult a Rabbi before proceeding. The NHS can arrange this.
- Hinduism: Supported as an act of Daan (selfless giving), consistent with the concept of Sewa (service to others).
- Sikhism: Supported under the principle of Seva. Lord Singh of Wimbledon CBE has stated it is “consistent with and in the spirit of Sikh teachings.”
If you are uncertain about your own faith’s position, the NHS has guidance for each major religion at organdonation.nhs.uk/your-faith.
Living donation
You do not have to wait until death to donate. Living donation allows healthy people to donate a kidney or a portion of their liver while alive.
In 2024/25, living donors accounted for more than 40% of all UK donations — 991 people donated a kidney or part of their liver. All living donor transplants are regulated by the Human Tissue Authority and involve thorough medical and psychological assessment.
Frequently asked questions
Does registering as a donor mean doctors will give up on saving my life? No. Donation is only considered after all efforts to save the patient’s life have been exhausted. The medical team treating you is always separate from the transplant team.
Can I donate if I have a history of drug use? Past drug use does not automatically disqualify you — each case is assessed clinically at the time of death.
What if I change my mind? You can update your registration at any time at organdonation.nhs.uk. Your most recent decision is what stands.
My child is under 18 — do I need to register anything? Children under 18 are excluded from deemed consent. If no decision is registered and a child dies in circumstances where donation is possible, the decision falls to parents or guardians. You can register a decision on your child’s behalf at any age through the NHS Organ Donor Register.
Is a driving licence registration enough? You can note your preference on a driving licence, but the NHS Organ Donor Register is the definitive record. Register there to be certain your wishes are recorded.
Summary
- All four UK nations operate an opt-out organ donation system — if you have not registered a decision and you die in circumstances where donation is possible, consent is assumed
- You can register your decision — to donate all organs, specific organs, or none — at organdonation.nhs.uk in two minutes
- There is no upper age limit; specialist clinical staff assess suitability case by case
- Donation does not affect funeral arrangements or prevent an open casket funeral
- Most major faiths support organ donation, or leave it to individual conscience
- Telling your family your wishes is as important as registering — families who know what their loved one wanted are far more likely to support donation
If you are working through other planning-ahead decisions, you may also find our guides on lasting power of attorney, advance decisions, and pre-paid funeral plans useful.
Sources
- NHS Organ Donation – UK laws
- NHS Organ Donation – register your decision
- NHS Organ Donation – what can you donate
- NHS Organ Donation – who can donate
- NHS Organ Donation – talk to your loved ones
- NHS Organ Donation – your faith and beliefs
- NHS Blood and Transplant – statistics
- Organ Donation Northern Ireland – changes to the law
- Human Tissue Authority