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With aims to both increase organ supply and better reflect individual donation preferences, many nations worldwide have shifted from 'opt-in' to 'opt-out' systems for post-mortem organ donation (PMOD). In such countries, while a prospective donor's willingness to donate their organs/tissues for PMOD was previously ascertained – at least partially – by their having recorded positive donation preferences on an official register prior to death, this willingness is now presumed or inferred – at least partially - from their not having recorded an objection to PMOD – on an official organ donation register. Using evidence regarding the presence and prevalence of selective donation preferences, and via exploration of how appeals to donation preferences are used to both motivate and legitimate shifts to opt-out frameworks, this paper draws attention to a set of previously unexplored problems for opt-out organ donation arising in contexts where: 1. Individuals demonstrate selective post-mortem organ/tissue donation preferences; 2. Legislation provides prospective donors with the opportunity to selectively permit/refuse the donation of certain organs/tissues in line with these preferences. While selective preferences pose few problems for opt-in systems where a selective occasion is built into the process of signing the donor register, this is not the case for opt-out systems. The loss of this selective occasion can cause significant problems where appeals to preferences motivate/legitimate shifts to opt-out but evidence regarding variable preferences does not feed into determinations regarding organ/tissue exclusions. The nature of these problems depends on how the authorisation aspect of 'opt out' systems is framed (e.g., as presumed consent, deemed consent or, given the role of familial consent in many jurisdictions as consent in name only).

Onora O'Neill is one of the foremost moral philosophers writing today. Her work on ethics and bioethics, political philosophy and the philosophy of Kant is extremely influential. Her landmark Reith Lectures on trust did much to establish the subject not only on the philosophical and political agenda but in the world of media, business and law more widely.Reading Onora O'Neill is the first book to examine and critically appraise the work of this important thinker. It includes specially commissioned chapters by leading international philosophers in ethics, Kantian philoso