To Be Oneself Again: All Icelanders Are Now Organ Donors By Default

Earlier this month, Iceland made headlines when Parliament passed into law a measure that officially recognises all Icelanders as organ donors by default, unless they specify otherwise ahead of time.

The idea is not new in Europe. Many European countries use this “opt-out” system, and now Iceland is amongst them. The idea is not new in Iceland, either. Six years ago, then Progressive Party MP Siv Friðleifsdóttir submitted a parliamentary proposal calling for the country to take up the opt-out system.

“SÍBS [an Icelandic health care non-profit] held a meeting at Iðnó, and invited a bunch of politicians to come, and I went on behalf of my party,” she recounts. “One question they posed to us was, ‘Will you pledge to stand for this issue?’ — to change the law so that one is assumed to consent [to donating organs] rather than assumed to have denied it. I started thinking about it, and I thought it was a good idea, so I began looking into it. That’s how it began.”

How “opting in” fails

Amongst the countries that use the opt-out system is Austria. In a New York Times piece from 2009, it was brought to light that 99% of its citizens donate their organs. By contrast, Germany, which uses an “opt-in” system, where people must expressly consent to donate their organs, only 12% did so.

The concept of the law is fairly simple. All Icelanders will be assumed to be organ donors by default, with two exceptions: if the deceased specified beforehand that they do not want their organs to be removed, or if the deceased said nothing on the matter but their closest relative objects.

Siv is not particularly worried about the next-of-kin clause to the law.

“This doesn’t control everything, because almost without exception, if the next of kin knows that the deceased wanted to donate their organs, then the next of kin does not object,” she says. “People want to respect the wishes of their dearly departed.”

Furthermore, those relatives who do give the green light for organ donation of their loved ones almost never regret the decision.

“Research has shown that next of kin who allow their departed’s organs to be donated feel good about the decision,” Siv says. “They feel as though their loved ones are, in some way, living on through other people. It becomes one bright point in the death of a loved one; that someone else will get to live because of their gift.”

A cause for celebration

Siv has a background in the healthcare industry, being a licensed physical therapist, and, as such, has passionate interest in the field. So the passage of the law came as a very pleasant surprise to her.

“It used to be that we were only receiving [organs], but in recent years we’ve been giving them, too. And it’s very important that we can give as much as we can.”

“This really pleased me,” she says. “I actually didn’t expect that it would be approved right now; I thought for sure it would be delayed. So I think it’s great that they’ve finally finished this project. When I look back, when it first got into this matter, I recall meeting this group of people who had received donated hearts, livers, kidneys and lungs. They had fought hard for this law. So when this law was passed, I really took this group to heart.”

Her tenure as a lawmaker has put her in contact with many people who have received organs, and one young woman she met still stays with her.

“I once heard a young woman at a meeting of the Rotary Club in Borgarnes, who had received a new liver. She described that with every breath, she felt better and better, because the new liver was starting to do its work. She was herself again. You just thought, ‘Wow, that was amazing. What a gift, just the right thing to do.'”

If you can, you should

The road to getting this law passed was not an easy one. Siv had actually submitted the measure as a parliamentary proposal twice during her 18 years in Parliament (note: parliamentary proposals are unlike bills; they propose government policy, but do not dictate its exact implementation like bills do). It even got as far as committee the first time, which recommended that the government make it into law. When her tenure in Parliament was over, amongst the works she handed over to Progressive Party MP Silja Dögg Gunnarsdóttir was this organ donor proposal, which Silja changed into a bill.

Now that this bill is law, Siv believes the real work can begin.

“I’ve just always been of the opinion that if you can help, you should help,” Siv says. “There’s a general shortage of organs in the world. As long as people are waiting for organs, there’s always a shortage. It used to be that we were only receiving them, but in recent years we’ve been giving them, too. And it’s very important that we can give as much as we can.”