Portugal switched from an opt-in to an opt-out system in the 1900s. Until 1993, an individual who wanted to be a donor had to communicate this to the Ministry of Health by express consent. In 1993, Portuguese law was changed to allow for presumed consent under Article no. 10 of Law no. 12/93 of 22 April, which states that “all national citizens and stateless persons and foreigners living in Portugal who have not reported their non-donor status to the Ministry of Health are considered potential post-mortem donors”.

Silent consent

The next question is inevitably how do I opt out of organ donation in Portugal if I don’t wish to be an organ donator? In Portugal, donation is by “silence-consent”. If you have said nothing, you are assumed to have given consent. Those who wish to oppose organ donation must express their dissent by registering in the RENNDA (National Register of Non-Donors). Except with the consent of the involved person, it is prohibited to reveal the identity of the donor or recipient of the organ or tissue.

Opting out is not straightforward, not surprisingly. Registration is carried out through the presentation, by the interested party or whoever represents them, at any health centre of a form from the Ministry of Health, approved by Normative Order no. 700/94, of 1 October. The web address is https://www.ipst.pt/index.php/pt/rennda

Receipt of the form is confirmed by the immediate delivery of a copy certifying the entry of the form into the services, legibly signed by the responsible employee or agent. Registration with RENNDA takes effect four working days after receipt of the form.

Should I opt out?

The demand for organs far exceeds the supply, leading to long waiting lists and preventable deaths. Opt-out organ donation policies increase donation rates.

Opt-out policies make donation the default option, which means that individuals are presumed to consent to donation unless they explicitly opt-out. This approach has been shown to increase donation rates significantly. For example, in Belgium, where an opt-out policy was introduced in 1986, the donation rate is over 30 per million population, compared to only 22 per million in Portugal. Opt-out policies also reduce the burden on families to make donation decisions, as the default option is to donate. This can alleviate the stress and emotional burden on families during a difficult time. Organ donation can save lives and improve health outcomes. A recent survey revealed that 60% or those questioned were unaware that Portugal had adopted an opt-out system.

Interestingly, Portugal works closely with Spain in locating suitable organs. Don’t worry, if you receive and organ from Spain, you won’t wake up after the operation speaking Spanish.

Portugal is a European leader in transplants

Portugal has become one of the countries with the highest organ donation rate per million inhabitants; in 2009, it was considered the second-highest European country in terms of donation rate. More recent data is hard to locate, between 2016 and 2018, the number of post-mortem donors remained constant but was higher than in 2011.

Knowledge on the concept of brain death

People with the potential of being donors after their death will have died in hospital. Death must occur in a hospital, in order to ensure that the organs are correctly harvested and that the necessary tests are carried out for the correct assessment of each potential donor. Specifically, brain death has to be established by suitably qualified surgeons.

The exception to this is a living donation, perhaps to a child or relative. In the case of living donation, this can happen if the conditions and requirements defined in Portuguese legislation are met. The donor must be of legal age and in good physical and mental health.

The medical teams at transplant units with a living donor program are responsible for evaluating the living donor, guaranteeing their rights, freedom of decision, voluntariness, gratuitousness and altruism. Each case has its own particularities, it is recommended that you consult the transplant unit to answer any questions about the living donation process.

A recent study amongst medical students found that 93% correctly understood the concept of brain death, correctly affirming that brain death occurs when the brain has no functionality, even when the heart continues to beat through artificial life support. However, only 64% were aware that individuals diagnosed with irreversible brain death but who continue to be sustained by artificial life support are potential post-mortem organ donors.

What about you?

It’s important to understand that the majority of potential organ donors will be young but people of all ages can be organ donors. One of the oldest organ donors in the United States, Carlton, was 92. He was a liver donor and saved the life of a 69-year-old woman. Not surprisingly the amount of people who were suitable for organ donation dropped dramatically after motorcycle helmets were made compulsory. You can draw your own conclusions from that fact.

If you feel strongly that you would not wish to donate organs after your death, don’t work on the assumption that age might rule you out. This is something few of us take seriously, but perhaps we should.

It is far from clear if relatives will be asked for consent if the person is suitable and has not registered to ‘opt-out’ The law says, “All national citizens, stateless persons and residents of Portugal who have not manifested their non-donor status to the Ministry of Health are considered potential post-mortem donors.”

Author

Resident in Portugal for 50 years, publishing and writing about Portugal since 1977. Privileged to have seen, firsthand, Portugal progress from a dictatorship (1974) into a stable democracy. 

Paul Luckman