Belgium

A central registration of non-donors was established in Belgium in 1987. Under this system, citizens of all ages can express their objection to organ or tissue donation, in their local town hall. Hence, this was also a system of presumed consent with the usual provision for a register of objections being made available. Parents may register their objections to transplantation for those of their children who are too young to make a decision for themselves, and a legal representative may register an objection on behalf of an adult who lacks the mental capacity to do so. The government set up a computerised system, a central health authority registry which is accessible to all transplant centres. The law itself (following its passage in 1986) reads:

Thus, the law requires the register to be checked before any organs are removed, but, despite the fact that Belgian law does not require the family to be consulted about donation, in practice, consultation is usually carried out (Kurnit (1994)). By the end of 1995, 1.75% of the native Belgian population and 3.23% of the foreign population had registered their objections to donation. A higher proportion of objections was found among young children whose parents had ‘opted out’ on their behalf and the level of objections decreased with age (that is, as the ages increased), so that only 0.5% of people over 69 years were on the register as objectors (see Roels (1997)). It has been argued by Kennedy et al (1998) that the lower rates of family objection, in comparison with the UK, may indicate that, while families are reluctant to take a personal decision about the removal of organs, they may find it easier in a system where failure to register an objection while alive can be understood as implicit consent to donation. If donation is seen as the norm and not the exception and where, in the absence of evidence to the contrary, consent is presumed, grieving relatives are relieved of the burden of making the decision about donation (see Kennedy et al (1998)).