Table 1 Consent systems in 10 European countries (1995–2005)

Presumed consent

Spain, Austria, Italy, France, Belgium, Sweden, the United Kingdom¹

Explicit consent

Germany, the Netherlands, Switzerland

Countries in which the legislative systems changed between 1995 en 2005

Sweden

On July 1 1996, Sweden changed from an explicit consent system to a presumed consent system. This change was accompanied by an information campaign to the Swedish public. All 4.2 million homes were informed about the system change and were neutrally motivated to take a stance in one or more of three ways: by telling next of kin, by signing a donor card, or by notifying the National Donor Register, established in 1996 [12].

Germany

On December 1 1997, the German Transplantation Act, in which an explicit consent system was laid down, came into force [4]. The passing of this Act was accompanied by a long and critical public debate, and several reports on organ donation in all media [50].

The Netherlands

In January 1998 the Netherlands laid down its explicit consent system in the Dutch Organ Donation Act. Along with the Organ Donation Act, a national donor registry (containing consents, refusals, or wishes that next of kin or specific person may decide) was implemented [4] and the Dutch Transplant Foundation was established. To accompany the introduction of the Organ Donation Act, the Dutch government supported neutral and soft-sell public campaigns [11]. Since 2000 the Dutch government has focused more on public recruitment campaigns and on supporting the process of organ donation in hospitals [34, 51].

Italy

Italy enacted its new transplantation law in 1999, introducing a presumed consent system. The introduction of this new legislation was accompanied by the founding of a national transplantation centre in 2000 and improved organization of the donation process [52].