I think the point you’ve made has highlighted to me a very practical, formatting issue relating to how I present the potential donation ethical principles. So, ‘voluntary’ and ‘ownership’ are two separate principles and values in my mind, rather than reading as one principle. I’ll be sure to make this clearer when writing up my ideas and sharing my thoughts on the topic.

Secondly, and to engage with your point more substantially, the donation ethical principle ‘voluntary’ emerged in the data set when participants discussed how genuine the consent was from donors under a deemed consent system. There was concern that a deemed consent policy laid open the possibility for organs to be retrieved from people who may not wish to donate but had not opted out of the system. At times, the opt out function was presented as attempting to avoid this from happening and yet, doubt was created when participants referred to the process of opting out and/or someone’s ability to opt out. The opt out process was described by participants as needing to be transparent and accessible to all. Such standards were implied to ensure that donation was voluntary despite the deemed consent policy, and people were not coerced into donating.

In terms of ‘ownership’ as another donation ethical principle, this arose when participants created uncertainty around how successful the deemed consent policy would be in practice. The family veto, societal culture surrounding death and body ownership, and the culture surrounding the act of donation were all depicted as hindering the potential success of the deemed consent policy. These perceived restrictions were implied to be rigid and immoveable. Alternatively, participants accepted that the deemed consent policy may lead to an increase in the number of donations, but its possible success was undermined and lacking justification by references to the intangible ‘costs’ to the culture of donation. The participants portrayed themselves as frustrated, and therefore implied they were supportive of organ donation, and increasing the number of donors, whilst also demonstrating insight into the family perspective and their involvement in organ donation decision making. The family were presented as powerful and incredibly influential in organ donation decision making. In one way this power was justified by references to societal perceptions of body ownership resting with relatives of the deceased. Yet, the power was also presented negatively as a possible cause for conflict between participants and family. In both instances, the deemed consent policy was implied as having either negative consequences ie “battles” with family, or “state ownership”. Alternatively, it would be simply ineffective, and unwarranted in the face of the family veto. For these participants, they were able to portray themselves as concerned about body ownership and valuing the voluntary nature of organ donation, which they presented as lost in the face of deemed consent and family veto.