In a hard opt-out organ donation system, which statement is true?

• A. Families are not consulted when assessing presumed consent.
• B. Families always decide after brain death.
• C. Consent requires explicit written permission.
• D. The government must conduct a public referendum.

Answer: (A)

In a hard opt-out system, the default is that a person’s organs can be donated unless they have explicitly opted out. This makes consent presumed rather than explicitly granted by the individual, and the legal determination rests on that presumed consent rather than requiring permission from the family at the moment of donation.

Because the policy treats consent as the default, the family’s role in assessing consent is not the legal basis for donation. That’s why the statement about families not being consulted when assessing presumed consent best fits the concept: the presumption is the starting point, not a family veto or required written authorization.

The other options don’t fit this framework. Explicit written permission isn’t required under a hard opt-out, since consent is presumed unless an opt-out exists. A public referendum isn’t a standard feature of hard opt-out systems, though policies can vary by country. And it isn’t accurate to say families always decide after brain death—the decision to donate in this setup is grounded in the presumed consent of the deceased, not a default family decision after brain death.