Advance Directives and Organ Donation Wishes in Northern Ireland

Since 1 June 2023, Northern Ireland operates a deemed consent system for organ donation under Dáithí's Law. If you're an adult resident, aren't in an excluded group, and haven't registered a decision to opt out, you're considered a potential organ donor after death. But "deemed consent" doesn't mean automatic retrieval — your family will still be consulted before any organs are taken, and their views carry significant practical weight even though they don't have a legal veto.

This creates a planning gap that an advance directive can close. An ADRT's primary purpose is refusing medical treatment while you're alive, but the document can also serve as the clearest possible record of what you want to happen after death — including organ donation and funeral arrangements.

How Dáithí's Law Changes the Default

Before 2023, Northern Ireland ran an opt-in system: you had to actively register on the NHS Organ Donor Register to be considered a donor. Dáithí's Law flipped this to opt-out. The excluded groups are narrow — under-18s, temporary residents, and people who lack the capacity to understand the deemed consent system.

If you fall outside those groups and haven't registered an opt-out decision with the NHS Organ Donor Register, the law deems you to have consented to donation.

In practice, though, clinical teams still approach the family. The family is consulted before retrieval even though deemed consent technically applies. This consultation isn't a legal requirement to obtain permission; it's a clinical and ethical convention that means your recorded wishes matter enormously.

Recording Organ Donation Wishes in Your ADRT

An ADRT is legally binding for treatment refusals, but its organ donation section operates differently. Organ retrieval happens after death, so it falls outside the scope of treatment consent during life. Your stated wishes about donation are treated as strong evidence of your views — highly persuasive to clinicians and family members — but they're not "binding" in the same way that a treatment refusal is.

Despite this distinction, including your donation wishes in the ADRT is one of the most effective things you can do:

• If you want to donate: state explicitly which organs and tissues you're willing to donate, or that you consent to donating all viable organs. This gives the transplant team direct evidence of your wishes and makes the family consultation significantly easier
• If you want to opt out: state that you do not consent to organ donation, and register your opt-out on the NHS Organ Donor Register. The ADRT reinforces the register entry and removes ambiguity if there's any dispute
• If you have conditions: you might want to donate kidneys and corneas but not other organs, or you might be willing to donate for transplant but not for research. Specificity is your ally — write exactly what you're comfortable with

What About Funeral Wishes?

An ADRT is also a practical place to record funeral preferences — burial or cremation, religious or secular service, specific readings or music, whether you want embalming, whether you'd consider a direct cremation without a ceremony.

These wishes aren't legally binding either. Tell the person arranging the funeral about them directly. A clearly documented funeral plan in the same package as the ADRT gives whoever arranges the funeral strong evidence of what the deceased actually wanted, and makes it much harder for family members to override those wishes with their own preferences.

If you've been to a funeral that got it completely wrong — the wrong music, the wrong tone, religious elements the person would have hated — you understand why writing this down matters.

Practical Steps

The most robust approach combines three documents:

1. ADRT: your treatment refusals (legally binding) plus your organ donation and funeral wishes (strong evidence of wishes, not binding in the same way)
2. NHS Organ Donor Register: register your decision — whether opt-in for specific organs or opt-out — so it appears in the clinical system
3. Will: name an executor and include any funeral-specific instructions, while also telling the person who will arrange the funeral where those instructions are kept

These three documents create redundancy. If one isn't available when decisions need to be made, the others still record your position.

The Northern Ireland ADRT guide includes dedicated sections on organ donation under Dáithí's Law and recording funeral preferences alongside your treatment refusals — so everything is in one place, documented properly, and accessible to the people who'll need it.

See more Northern Ireland guides →