Most of us have thought about organ donation in a vague sort of way. We might have carried a donor card at some point, or ticked a box on a driving licence application years ago, and then never thought about it again. But Ireland’s law changed on 17 June 2025, and the change is significant enough that it is worth ten minutes of your attention, particularly if you are in your 50s, 60s or 70s.
Here is the part that surprises people most: age is not the barrier you probably assume it is. Ireland has one of the lowest rates of donation from people over 60 in the EU, and a good deal of that comes down to a belief, held by families and sometimes by clinicians, that older organs are not wanted. That belief costs lives.
TL;DR
- Since 17 June 2025, Ireland operates a soft opt-out system under the Human Tissue Act 2024: adults are presumed to consent to organ donation unless they have joined the opt-out register.
- Your family still has the final say. A designated family member must confirm in writing that they have no objection before donation can proceed, so telling them your wishes matters more than any card.
- Age alone is not a barrier. People donate successfully into their 60s and 70s, and for corneas age is not a factor at all. Physical condition, not birth date, decides suitability.
- Ireland ranked 22nd of 27 EU countries in 2023 for deceased donation among people over 60, and just 202 transplants took place in 2025, the lowest total in five years.
- If you would rather not donate, you can join the HSE opt-out register free at hse.ie/organdonation or by ringing HSE Live on 1800 700 700. You can add or remove your name at any time.
What actually changed in June 2025
Part 2 of the Human Tissue (Transplantation, Post-Mortem, Anatomical Examination and Public Display) Act 2024 commenced on 17 June 2025. It moved Ireland from an opt-in system, where you had to signal willingness, to what is called soft opt-out, or deemed consent.
In plain terms: if you are an adult living in Ireland and you die in circumstances where donation is medically possible, you are presumed to have agreed to donate your organs, unless you have recorded a decision not to.
The word “soft” is doing real work in that phrase, and we will come back to it, because it is the single most misunderstood part of the new law.
Who deemed consent does not apply to
The presumption does not cover everyone. You are outside it if you are:
- Under 18
- Not ordinarily resident in the State for at least 12 months before your death
- A person who lacked the capacity to understand the change in the law for a significant period before death
- Someone who had made a known, sustained objection to donation
For everyone else, the presumption applies. It applies to organs: kidneys, liver, lungs, heart and pancreas. Tissue donation, including corneas, is handled under separate arrangements rather than by deemed consent.
Your family still decides, which is why the conversation matters
This is the point that gets lost in headlines about “presumed consent”. Under Irish law, a doctor cannot proceed with donation unless a designated family member confirms in writing that they have no objection.
The Act sets out a ranked list of who that designated family member is, beginning with a spouse or civil partner and working down through close relatives to, at the end of the list, a friend of long standing. Where several people share the highest applicable rank, such as three adult children, a single objection from any one of them is enough to stop the donation.
So the law has not taken the decision away from families. What it has done is change the default question they are asked, from “would he have wanted this?” to “is there any reason he would not have wanted this?” That is a gentler question to face at four in the morning in a hospital corridor, but it is only gentle if your family actually knows the answer.
If they have never heard you say a word about it, they are still guessing. And families who are guessing, understandably, tend to say no.
The Irish Kidney Association still issues an organ donor card, now available as a digital card you can keep in your phone’s wallet. It carries no legal weight whatsoever. Its entire value is as a conversation starter and as evidence of what you wanted, and on that basis it is well worth having.
The age myth, and why it matters here
Ask most people over 60 whether they could be an organ donor and a good many will say they are too old. The evidence says otherwise.
The HSE is clear that donation is possible well into a person’s 60s and 70s. It is physical condition, not chronological age, that determines whether an organ is suitable, and that assessment is made by the transplant team at the time, not by a cut-off on a form. For corneal donation, age is not a consideration at all.
Yet Ireland’s numbers tell a different story. In 2023, Ireland ranked 22nd out of 27 EU countries for deceased donation per million population among people over 60. The average age of an Irish deceased donor sits in the 40s, notably younger than in the countries with the strongest donation and transplant rates. An advisory group looking at this concluded bluntly that age alone should not be a factor, and called for a cultural shift across the health service.
Some of that shift is clinical. But a meaningful share of it is simply older adults, and their families, ruling themselves out of a decision that was never theirs to rule out.
Why the numbers matter right now
In 2025, 202 organ transplants took place in Ireland, from 68 deceased donors and 29 living donors. That was the lowest annual total in five years, and well below the pre-pandemic five-year average of 282. The breakdown was 136 kidney, 28 liver, 16 lung, seven heart and five pancreas transplants.
Around 600 people are currently waiting, the overwhelming majority of them for a kidney. The Irish Kidney Association, which runs Organ Donor Awareness Week each May alongside the HSE’s Organ Donation Transplant Ireland, has called for greater investment in transplant infrastructure and in living donation to close that gap.
If you would rather not donate
Opting out is a legitimate choice and the system is built to respect it properly. You can add your name to the HSE’s opt-out register at hse.ie/organdonation, or by ringing HSE Live free on 1800 700 700 if you do not have a PPS number or run into difficulty online.
If your name is on the register, your organs will not be donated and, importantly, your next of kin will not be asked about it at all. There is no deadline and no closing date, and you can remove your name again at any point if you change your mind.
Living donation and body donation
Living donation, most commonly of a kidney, is a separate pathway entirely and accounted for 29 of last year’s donations. It involves thorough medical and psychological assessment, and it is worth asking your GP about if someone in your family is on a waiting list.
Donating your body to medical science is different again. It is not covered by the opt-out system and must be arranged in advance, directly with the anatomy department of a university medical school. If that interests you, contact the school directly, as each has its own requirements.
Add it to the list of things you have already sorted
If you have made a will, set up an Enduring Power of Attorney or drafted an advance healthcare directive, you have already done the harder emotional work. This one takes a single conversation.
Tell your spouse or partner. Tell your adult children. Say it plainly enough that they will remember it, and say it once more some other time so it lands. You are not being morbid; you are removing a decision from people who will be in no state to make it.
At Críonna Health we write a good deal about planning ahead, because the people who age best are rarely the luckiest ones. They are the ones who had the awkward conversations early, while there was no urgency, and then got on with living.
This is a ten-minute version of that. Worth doing over the tea.
This article is for general information and is not medical or legal advice. For guidance on your own circumstances, speak to your GP or see hse.ie/organdonation.
📷 Photo by Vitaly Gariev on Unsplash
