Ten years ago, Wales made history by becoming the first nation in the UK to introduce a "soft" opt-out system for organ donation. On December 1, 2015, The Human Transplantation Act came into force, shifting the default so that all adults are presumed to consent to organ donation after death unless they have explicitly opted out. The law, often referred to as "deemed consent," was hailed as a potential game-changer for thousands waiting for transplants and quickly became a model for other UK nations. But a decade on, the impact of this pioneering legislation is being debated, with families, recipients, and experts weighing in on its successes and ongoing challenges.
Since the law took effect, more than 2,000 organs have been donated in Wales, including 640 organs from 198 deceased donors under deemed consent, with 550 of those transplanted, according to Nation.Cymru. Across the UK, over 44,000 people have benefited from deceased and living donor transplants in the last ten years. Yet, the journey has been far from straightforward, and the law’s real-world effects are more complex than the headlines once promised.
For individuals like Stewart Cleaver, a 39-year-old kidney transplant recipient from Neath, the law—and organ donation more broadly—has been nothing short of life-changing. Cleaver, who suffered from polycystic kidney disease and endured grueling dialysis sessions, recalls the day he received what he calls "the greatest phone call ever"—news that a kidney was available for him in Cardiff. "I couldn’t believe it at first. You can’t get your hopes up too much in case it’s not a match. But it was fine and the doctor said they could do it there and then," Cleaver told Nation.Cymru. After the transplant, he said, "I felt really well straight away. It’s a surreal situation to be in but it’s such an appreciative moment – you can’t explain it really." He never learned the identity of his donor but was able to send a thank you letter to her family, expressing gratitude for the gift that restored his health.
But while stories like Cleaver’s are inspiring, the statistics reveal a more sobering reality. Despite the initial optimism, the number of people waiting for transplants in Wales remains stubbornly high. Over the past decade, 217 people in Wales have died while waiting for an organ, and in west Wales alone, 137 people are currently on the transplant waiting list, with 123 referrals in 2025 so far. Across the UK, the waiting list has reached a record high, with more than 8,200 people hoping for a life-saving transplant, as reported by the BBC.
The law’s introduction did bring a notable, if short-lived, boost. The organ donor consent rate in Wales rose by about 15% during the first three years after the law’s introduction. However, this momentum was not sustained. By 2024, consent rates had dropped to their lowest point in a decade. The NHS Blood and Transplant service (NHSBT) cautioned that presumed consent "was not a silver bullet to closing the gap between donation and transplantation." According to NHSBT, factors contributing to the decline included the Covid pandemic, fewer large media campaigns, limited resources, and a possible erosion of public trust in the health service.
Leah McLaughlin, a healthcare scientist at Bangor University, told the BBC, "We also need more messages embedded in day-to-day life so it becomes more of a normal expected end of life care, which is what NHSBT is trying to do, but we do need the infrastructure to support those messages." She also pointed to staffing shortages and a lack of prioritization for organ donation within the health system. "Nurses are understaffed and organ donation isn't seen as a priority," McLaughlin said.
Personal stories continue to highlight both the hope and the heartbreak involved. When 18-year-old Conner Marshall was murdered in Porthcawl in 2015, his family faced the wrenching decision of whether to honor his wish to donate his organs. His mother, Nadine, recalled a brief conversation they had had while Conner was applying for a motorcycle license. "We talked about it but, only briefly, what it meant to be an organ donor and he said 'well, who wouldn't want a piece of this?' But he was quite emphatic that he didn't want [to donate] his eyes." Ultimately, the family chose to proceed, benefiting three recipients. Nadine Marshall described the process as "so dignified and so sensitive to Conner. It was truly a humbling experience to be able to do it."
Another moving account comes from Anna-Louise Bates, who lost her husband and seven-year-old son, Fraser, after they were hit by a car. She chose to donate their organs and later founded the charity Believe ODS to support organ donation and reduce stigma. Bates told the BBC, "It was ground-breaking in Wales to be the first to adopt the soft opt-out, but everyone is still not educated in what that actually means." This drive for greater education and awareness led to the creation of a memorial garden at Thornhill cemetery in Cardiff, which opened on December 1, 2025, to honor donors and educate the public about the law.
The law’s "soft" opt-out approach still gives families the final say. If a decision isn’t registered, relatives can object to donation—even if the deceased was listed as a donor. This nuance, while designed to respect family wishes, can lead to confusion and, at times, missed opportunities for donation. Charlotte Charles-Williams, lead organ donation nurse in south Wales, noted that conversations with grieving families are "more difficult" if there hasn’t been a prior discussion or a registered decision.
There are also disparities in support for organ donation. Research cited by the BBC found that support among minority ethnic communities in England is 20% lower than in the general population. A similar pattern exists in Wales, even though the overall numbers are smaller. Minority communities are over-represented on transplant waiting lists and among those who opt out, a situation exacerbated by targeted misinformation campaigns. NHSBT reported a slight increase in minority ethnic registrations over the past five years, but acknowledged "still more work to be done."
Despite the challenges, there are signs of progress. Official data shows that the number of organ donations in recent months in Wales has reached its highest level since before the pandemic. The Welsh government, recognizing the pandemic’s impact on public attitudes and donation rates, stated that "there are signs this year that the consent rate in Wales may be recovering" and that "a significant amount of work [is] planned to continue to improve it."
Anthony Clarkson, director of organ donation and transplantation at NHS Blood and Transplant, remains hopeful. He noted that last year, 90% of UK families honored their loved ones’ decisions to become donors. "People are far more likely to support donation when they know it’s what their relative wanted," he told Nation.Cymru. He encouraged everyone to register their wishes and share them with family, emphasizing that "it only takes two minutes to register and could save the lives of people who so desperately need a transplant."
For transplant recipients like Sonsare Zabadi from Cardiff, the value of donation is deeply personal. Zabadi, who signed the register in 2012 and received a double lung transplant in 2023, reflected on how his family’s perspective changed after his experience. "Fast forward to 2023 when I had my transplant, I remember [a family member] visited the hospital and looked at me and said 'I get it now, and I see why it’s important that we all look to do this.'"
As Wales marks a decade since its bold step into presumed consent, the legacy of the law is still being written. Progress is evident, but so too are the hurdles. The stories of donors, recipients, and families across the country underscore both the life-saving potential and the ongoing need for education, resources, and honest conversation about organ donation.
