Five years of the new Organ Donation Act: what has the law achieved?

In July 2020, the Organ Donation Act changed in the Netherlands. Previously, people had to take action themselves to register as a donor ('opt-in'). Under the new law with the 'opt-out' system, every adult receives a registration in the Donor Register. Anyone who does not record a choice is registered as 'No objection to organ donation', which is equivalent to consent.

The primary goal of this method was to increase consent for organ and tissue donation and ultimately raise the number of donors.

What has that yielded after five years? Researchers examined developments in the Netherlands and England, where a transition from an opt-in consent system to an opt-out was made at virtually the same time. They looked at donor registrations, consent for donation, and the number of actual donors.

The choice of every adult is known.

A choice has now been recorded for the entire adult Dutch population. In January 2026, 34 percent were registered with 'Yes, I want to be a donor', 24 percent with 'No objection', and 31 percent chose 'No, I do not want to be a donor'. The remaining 11 percent leave the decision to surviving relatives or a specifically designated person. Combined, 58 percent have a registration that makes organ or tissue donation possible.

The large number of people who registered 'no' is striking. But that too is an important gain of the law: a clear choice by these people that they do not want to donate. Furthermore, healthcare professionals and relatives are now more often aware of what the individual actually wanted. Under the old law, families frequently had to discuss donation without knowing their loved one's preference.

Consent more frequent during donation discussions

If someone is medically eligible for organ donation, their registration serves as the starting point for the conversation with the family. If you look solely at the families with whom such a donation discussion took place, a change can be seen since the law was amended.

In the three years prior to the new law, the annual consent rate was between 42 and 45 percent. In 2020, that was 48 percent.

Following the introduction of the law, this rose to 60 percent in 2021 and 2022, and to 61 percent in 2023. In 2025, it was 56 percent.

If you include all potential donors, including people who registered 'no', the difference is much smaller. The total consent rate remained around 35 percent between 2017 and 2025. The researchers found no statistically significant increase after the introduction of the new law. Consequently, consent is granted more often during actual donation discussions than under the old law, but the increase across the entire group of potential donors is limited.

'No objection' sometimes difficult

Registration of consent based on 'no objection' requires attention. If someone is explicitly registered with 'yes', the family usually supports the donation. However, in the case of 'no objection', this did not happen in more than half of the cases. It would help if people discussed their registration with their loved ones, who would then know both what is in the Donor Register and how the person felt about it.

For healthcare professionals too, a donation discussion based on 'no objection' can be challenging. The law was introduced in the middle of the coronavirus pandemic, meaning that communication training for this was not always possible. Moreover, intensivists do not frequently conduct such conversations in any case. Furthermore, months or even years can pass after training before they experience their first 'no objection' situation. Training, support, and experience therefore remain important.

More donors, but not just because of the law

The number of deceased organ donors in the Netherlands has increased in recent years. However, this increase cannot be attributed solely to the new Organ Donation Act. In 2024, there were 360, the highest number in the studied period. Organ donation after euthanasia is also becoming more common: rising from 13 in 2022 to 34 in 2025.

The researchers cite several reasons for the increase, including: broader possibilities for donating organs that were previously considered unsuitable, new techniques to evaluate and improve organs within the donor or on a machine, and since 2021: heart donation after circulatory death.

Incidentally, in England, the number of donors did not rise above pre-coronavirus pandemic levels following the introduction of the opt-out system. The consent rate among approached families also declined there. However, the countries cannot be compared one-to-one: their registration and consent systems differ.

Law alone is not enough

After five years, it appears that the Dutch Organ Donation Act has provided more clarity regarding the wishes of potential donors. Additionally, consent is given more frequently during donation conversations than under the old law, and there are more realized donors.

At the same time, the total consent among all potential donors has changed only to a limited extent. The researchers conclude that a legislative amendment alone is not enough to increase organ donation. A good infrastructure, training for healthcare professionals, and continuous attention to organ donation through campaigns and other means remain necessary.

View the full scientific research in Transplant International.