From 20 May 2020 organ donation in England has moved to an 'opt out' system, also known Max and Keira's Law in memory of Keira Ball, who died age 9 in 2017 and Max Johnson, now age 12, who was saved by her heart.

Detailed guidance on the changes to the law and the choices you can make can be found at and includes an easy-read factsheet

In summary all adults in England will be considered to have agreed to be an organ donor when they die unless they have recorded a decision not to donate or are in an excluded group.

The excluded groups include:

 - individuals under 18 (children)

 - people who lack the mental capacity to understand what organ donation is and the choices available to them

 - visitors to England, and those not living in England voluntarily e.g. soldiers

 - people who have lived in England for less than 12 months before their death

The guidance explains that if you do not want to donate your organs or you have specific wishes about which organs you would or would not like to donate, you should record your donation decision on the NHS Organ Donor Register. You can amend/update your wishes on the Register at any time.

If you prefer not to have your wishes recorded on the Register you must tell your family (or nominated representative(s)) your donation wishes and ask them to honour them on your behalf. Your organs will not be donated without their consent. This can be done in conjunction with other requests you might like to make with your family in the event of a death, to include a roadmap of how you wish the family to respond following the news, such as how you wish the death to be communicated to any businesses you have interests in, how staff are protected, who might take ownership of dealing with financial matters – right through to how you wish future family investment to be made to protect family values. You can work with your advisers to draft these wishes, so any decision is not made in isolation, but in tune with your family values. This is often also referred to as a “family charter” or “family governance” guidance note.

See further, the FAQ on the ‘opt-out’ system

If you have not expressed a decision to opt out of donation and are not in an excluded group, it will be considered that you consent to donate your organs.

Organ donation remains your choice but you need to take decisive action if you wish to ‘opt out’ or have specific wishes.