Introduction: All countries within the United Kingdom have now adopted an Opt-out consent legislation,except for the Isle of Man. All Specialist Nurses in organ donation have received extensive training to adhere to the consent model applicable in their respective regions.However,despite these legal changes,consent rates are noti mproving and this has an impact on those waiting for life-saving organ transplants.Recognising this challenge,it is imperative to explore the perspectives of Specialist Nurses regarding the legislation to identify any potential barriers to consent.
Methods: A comprehensive Microsoft Forms questionnaire,consisting of nine questionscovering both quantitative and qualitative aspects, was disseminated via email to the entire SN workforce. Recognising that SNs are often occupied with demanding responsibilities,the survey aimed to gather valuable insights on the recent legislation change whilst minimising disruption to their busy schedules. SNs were actively encouraged to participate and complete the questionnaire, understanding the importance of their input and the value of their perspectives.Following the initial email outreach,a reminder was sent out one week later to prompt any remaining Specialist Nurses to complete the questionnaire.
Qualitative thematic analysis was conducted to categorize responses to open-ended questions into positive,neutral and negative sentiments regarding the legislation.
Findings: Among approximately 300 Specialist Nurses currently active in the UK,feedback was received from 141 individuals. Repsonses represented all 12 Regional Organ DonationTeams,with the majority of pariticpants having served in their role for over five years.Nearly allr espondents(with only one exception) reported undergoing specialised training in discussing the legislation with potential donor families.
Interestingly,the majority(61%) felt that the legislation did not aid conversations effectively,while a mere 8% believed it contributed to improved consent rates.
Discussion: Opt-in registrations continue to provide the most likely source ofc onsent for donation¹.The feedback from Specialist Nurses suggests a prevailing sentimentr egarding the necessity for enhanced public education on donation and the legislation.It becomes apparent that organ donation entails numerous intriciate  challenges beyond the scope of legislative amendments alone.While legislative changes aim to address certain aspects,the repsonses indicate a broader acknowledgment that they are not signularly effecive in fostering higherconsent rates.This highlights the importance of a multifacted approach,incorportating education initiatives alongside legal reforms,to truly make strides in improving consent rates for organ and tissue donation.

¹ Organ and Tissue Donation and Transplantation Activity Report 2022/23 NHS Blood and Transplant