Provocation, Vital Circulations: Organ Donor Cards

Do you carry a donor card? In May 2020 organ donation law has changed in England, moving from consent to an opt-out system of organ donation based on presumed consent. The organ donation card suddenly looks like an obsolete object. Why carry a card, if one’s consent is presumed? The solution for those wishing to opt-out might be to carry a non-donor card? No such object exists so far, and one can surmise why not? Non-donor cards are in circulation in Japan, for instance. In England, opt-outs can be expressed via the online donor register only.

Yet NHSBT continues to encourage people to carry donor card. It is still valued, not as a form of consent, but as one of the relevant signs of one’s intention. Donor cards were never legally binding, but this does not mean they are legally, socially, culturally insignificant. There is a long tradition of public health messaging encouraging people to sign their donor card, and that carrying that signed card could save life. In reality, the card was always limited, and subdued by other mechanisms of certifying consent.

In recent years, in England and elsewhere, there is more open admission and discussion that to the same extent that consent forms do not represent consent, donor cards do not stand in for consent to donate. The emphasis in public health messaging has shifted in recent years to encouraging people to talk about organ donation with their family members. The most recent version of the organ donation card (they are still very much available, in circulation and encouraged) certifies not only the wish to donate, but that the card holder has spoken to their family. Tensions between family consent and individual consent are still at the heart of tensions in ICU and organ donation units. Is it time for a socio-legal history of organ donor cards?

(Author: Professor Marie-­Andrée Jacob )

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