Table 2.

Comparison of previous opt-in and new soft out-opt system. Adapted from [11]

Decision Type
	Active	Passive	Family consent	Geographical reach	Role of family
Former Opt-in system	Register to opt in on the organ donor register Verbally tell a relative or friend you want or do not want to be a donor Write telling a relative or friend you want or do not want to be a donor Nominate a representative to make the decision for you. (Nowhere to record this decision)	Do nothing and remain a non-donor unless your relative gives consent to organ donation.	Person under 18, lacks mental capacity	UK wide	To give assent or agreement or veto for organ donation if their relative has actively opted in, or to make a donation decision on behalf of their relative.
New Opt-Out System in Wales	Register to opt-in on the organ donor register Verbally tell a relative or friend you want to be a donor Write telling a relative or friend you want or do not want to be a donor Register to opt-out on the organ donor register Appoint a patient representative on the organ donor register to make the decision for you	Do nothing and remain as a donor (Deemed consent)	Person under 18, lacks mental capacity	Wales only Welsh citizens have to die in Wales for the soft-opt out to apply. If they die in England the opt-in system applies.	To support the donation decision of their relative made in life. Clinicians acknowledged that they would not pursue organ donation if the family member refused to support their relative’s donation decision made in life as the family still have a legal right to override their relative’s decision.