Over 60’000 people are on waiting lists for donor organs in the European Union. However, only a tiny fraction of Europeans register as organ donors, and a chronic shortage of donors across the EU means that thousands of people die each year waiting for a suitable transplant.

When a person leaves no instructions about organ donation during their lifetime, then doctors often seek consent from next of kin after they have died. Unsure what their relatives would have wanted, the vast majority reject donation, and healthy organs are buried or cremated. It’s a difficult ethical issue and it seems ghoulish to talk of organs being ‘wasted’, but thousands of lives could be saved if more people donated.

There are various different systems for determining consent across Europe, and it is entirely up to each EU Member State to decide for themselves which they choose. Generally speaking, ‘opt-in’ donation strategies means that nobody’s organs are used without their consent, whereas ‘opt-out’ strategies mean that everyone is treated as a potential donor unless they specifically refuse.

Should more countries use an ‘opt-out’ system for organ donation? To get a reaction, we spoke to Professor Anthony Warrens, Dean for education at Barts and the London School of Medicine and a consultant renal physician at the Royal London Hospital. What did he think?

warrensMy own view is probably not. I prefer it to be an active decision to opt-in, and what we want to do is to make people as aware as possible of the opportunity… I think it goes against the grain to make assumptions about something as important as that, so I’m not in favour of it.

To get another reaction, we also spoke to Willem Weimar, Professor of Internal Medicine at the Erasmus University Rotterdam and a council member of the European Society for Organ Transplantation (ESOT). What did he think about ‘opt-out’ systems?

weimarWell, an ‘opt-out’ system might be a good solution for the shortage of organ donors, but it raises ethical questions about the autonomy of people. When you think that individual autonomy is one of the quintessential components of ethical behaviour, then people should always indicate themselves whether they want to become an organ donor or not…

Finally, we spoke to Bernadette Haase, Director of the Dutch Transplant Foundation. Did she think that people should be automatically registered as organ donors, with the option to ‘opt-out’ if they wanted?

That is [a] difficult question. My personal opinion is that this could be a good solution. For example, in the Netherlands our biggest problem is that a large number of next of kin refuse organ donation when they are confronted with the donation request. Many people have never thought about donation until the moment the question is actually asked. So often they refuse because they do not know what the deceased would have wanted.

When you have a presumed consent system, the automatic assumption is that people consent to donation unless they explicitly opt out. And that could make a big difference. Currently, in the Netherlands, it’s the other way around. The Dutch refusal rate is high: over 60 percent.

It is important to realize that it’s not just about the consent of the next of kin or the potential donor, but also about ensuring that the environment in hospitals is well developed. For example, ensuring that, when you die, you are recognised as a potential donor. That’s the first step. The next step is that hospitals create an environment where next of kin feel safe; that they can trust the doctors so they know that a loved one who has just died is in good hands. That also helps to improve the chance of consent.. So, introducing automatic donorship is not the only solution. We need a combination of legislation, informing the public, and educating medical professionals in hospitals.

Should everyone be considered organ donors unless they ‘opt-out’? How can more people be encouraged to register as organ donors? Let us know your thoughts and comments in the form below, and we’ll take them to policymakers and experts for their reactions!

IMAGE CREDITS: CC / Flickr – Francesca Palazzi

168 comments Post a commentcomment

What do YOU think?

  1. avatar
    Dimitris Athanasopoulos

    In my opinion, when someone dies in a hospital in a young age, organ donation should be mandatory (if he/she was healthy). Imagine how many lives we can save with liver, eyes, heart, kidney donations!

    Many people now die and take valuable organs to their grave!

    • avatar

      But then everything will be a choice of the doctors performing the surgury in question. Imagine what prices will have any healthy organ and how easy it will be for the doctor to kill one healthy patient in order to save three others which would give him enough money for these organs.

    • avatar
      Robert Birchall

      In the UK we have the NHS which totally removes the problem of individual doctors seeking any pecuniary advantage gained by prematurely ending a patients life. One more advantage of having a properly funded and organised health service for the use all citizens.

    • avatar
      David Norris

      So taking what does not belong to you is ethical as long as it saves lives? Is that it? I have no recollection of opting into such a scheme, let alone requiring the need to opt out of one. Consent first. Not assume that a person already belongs to the the state. They refuse to bury you for nothing these days. Why should our organs come free. Mandatory my Arse!

    • avatar

      You neglect to examine the incredible amount of money made in the organ industry just like the vaccine industry.
      Government’s do not have the right to force decisions upon what one has done with their body. Alive or Dead. Nor will they ever have that right regardless of what claims and overtures they may make.
      You discount the varying beliefs and values people have.

      Here in Australia the Organ Donor Register tries to claim most religions support organ donation. A subtle attempt to move down the same line of argument used to force everyone to be vaccinated in Australia (well coerced by not giving them payments the government returns past taxes to families, called Family Tax Benefit).

      Little do they acknowledge that ones religious faith is not dictated by an institution but by ones conscience.

      The assumption must be in the negative unless the affirmative can be proven.
      This is the same “innocent until proven guilty” system that should operate in law.

      Unfortunately Governments across the world are taking a dystopian path of dictating and directing every aspect of an individuals life.
      This juggernaut of scientific socialism has to come to a stop.

      20/09/2017 Jennifer Reich, Associate Professor of Sociology at the University of Colorado, Denver, has responded to this comment.

    • avatar

      What gives any person the right to demand what people do with their or their childs body.

  2. avatar
    John Flerianos

    Fuck no. I’ll be the first to donate organs, but NOONE should be tricked to. It’s enough that the state owns you while you’re alive, don’t own us while we’re dead too.

  3. avatar
    Nando Aidos

    Instead of regulating organ donations, teach people and children about “organ donations” and you have the problem solved.
    And stop this “regulate everything” obsession!

  4. avatar

    Instead of regulating organ donations, teach people and children about “organ donations” and you will have the problem solved.
    Trust people and stop this “regulate everything” obsession!

  5. avatar
    Christopher Kwadwo Svanefalk

    Of course. Who would be so utterly selfish that they actually deprive others of life-saving surgery in order to keep their own dead bodies intact? When you are dead, you are dead. What happens to your body does not matter to you anymore. It is just common sense that you give others the chance to keep on living by having your organs transplanted.

    • avatar
      james pascoe

      and common decency! oh, by the way, I received a heart on Christmas 2005, and a kidney oct 2010. nuff said!

  6. avatar
    Robert W. Vagabond-Nomad

    Absolutely. Everybody should be automatically a member unless they specifically opt out.

    And if it were up to me, those who don’t want to be a donor shouldn’t be entitled to receiving from other donors either.

    • avatar
      james pascoe

      thank you Robert! I am a long time donor. but I never considered that someday I might be on a transplant list! now I have received TWO organs. I received a heart during Christmas 2005 and a kidney oct, 2010. I think, what if that was me. I decided not to be a donor because I didn,’t want anyone taking my body parts after I was dead. but then I was told you have very bad heart but we cannot give you a transplant because you decided you would not give anyone yours.

  7. avatar
    Jaroslav Aliasevic

    No way it’s same as legalization off government taxation which is out off limits!!! Let them eat when’s is election start and steal the last when government only needs!!!!

  8. avatar
    Costin Halaicu

    No. If we admit that individuals are the sole proprietors of their bodies, then their express consent is needed. Any other way would be an unjust appropriation.

  9. avatar
    Marko Sucic

    Croatian experience has been excellent, we have opt-out system but also nice campaigns to educate people about it…consequences are that many people are buying – even unnecessary – small bracelets that says – proud organ donor. We may be behind in many things, but we are currently 1# in the world in organ donations and transplantation procedures :)

  10. avatar

    Absolutely not, unless you want your organs to be “discounted”on some “Organs Dealership”. Buy a kidney, get the other half off !

  11. avatar
    Ferenc Lázár

    Definitely not! Organ donation can be used by science and doctors to “sell” parts of ones body to rich people, even when someone is in coma and might recover! There are such cases happened throughout Europe, so i wouldn’t trust most of doctors when money is involved..

  12. avatar
    catherine benning

    If the European people are not presently, of their own free will, opting into this option of donor for the incurable, then they are not interested in or wanting to become fodder of organ parts to save those who are unfortunate enough to face death. We all know the stories and can opt right now to be a donor ‘if we want to.’

    To now suggest they will be ‘forced’ or ‘compelled’ to do so, unless they opt out of the idea, (and how do you control their decision to make sure they are not dissected after death when they don’t want to be?) is a barbaric attempt at control beyond sanity. What is it with the EU they have this overriding need to impose their wishes on our nations people akin to the Hitler regime of old?

    If any medic came near my family or I to ask for such consent, and you know the pressure to say yes would be the equivalent and worse of the pro politically correct departments of any of these strange and growing sects, then I would lodge a complaint for offensive behaviour against them.

    The donation of human body parts has far more repercussions than any of these madmen want you to know or address. Take a look at these links. Not to mention the butchery that goes so badly wrong, very, very frequently.




    So, no, my body is mine and will remain so until I return to the energy and ashes I will become. Keep Frankensteins fingers outside my carcass.

    • avatar
      Steve palmer

      Benning, ..Oh please!..Get over yourself!! Karma and I can only hope you’ll need a transplant someday. You sound like a fucking asshole! Wake the fuck up. You have no idea what you’re even talking about. You’re another moron that has to run their large mouth for everyone to hear, and really, the sad fact is, people never give a shit or cares to learn and understand about organ donation until it affects them personally. Perhaps one day you’ll be touched by illness or accident and reconsider your ideas on the subject.

  13. avatar
    Valerio Pacci

    In a world where Profit is at the base of everything I say NO! Even thou I’ll be the first one to but no one should be “tricked” to….
    I agree with NandoA. John F…
    Remember the Toyota scandal… they had to choose between withdrew cars from the market OR pay lawyers for the eventual causalities, they had choose to pay for the lawyers and causalities.

  14. avatar
    TJ Todorov

    Yes, please yes. You die, and you don’t care anymore, but there is somebody to live.

  15. avatar
    Tarquin Farquhar

    If such a totalitarian edict is enacted then methinks films/books like SOYLENT GREEN and FRANKENSTEIN manifest greater prominence.

  16. avatar

    How about those who are incapable to express themselves?

  17. avatar
    Vinko Rajic

    YES , OK there is some bad problem . We can’t trust doctors . Maybe they just kill you and make a big money on the Spare Parts . I don’t care , I am going to donate everything if they want to some research institute like Karolinska Institutet (English)

  18. avatar
    Elena Simic

    definitely, i don’t see any ethical issue with this as each individual can, as said, opt-out.

  19. avatar
    Magda SouSilva

    Yes. Most people don’t think about it until it is too late, and asking family to allow it in five minutes is too cruel. If you feel so strongly against helping someone after you are dead, then opt out. And go burn in whatever hell you believe in.

  20. avatar
    Toni Muñiz

    My country, Spain, is probably the leading organ donor in the world. We are all considered donors but express consent must be adquired from family if not registered as donor.

  21. avatar
    Roberto Milan

    I see many comments about doctors as “organ trader”, but in which country do you live ? At least in Italy I feel safe about your worries

    • avatar
      Robert Birchall

      Italy I don’t mean to be offensive but what about the Mafia if there is any profit to be made.

  22. avatar
    Trevor Stammers

    Opt out legislation has gone so badly in some countries such as Brazil they had to revoke it almost immediately. It has not been particularly effective in Sweden either I gather. I have written about my concerns re possible adverse consequences when the legislation for opt-out comes into effect in Wales. http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=9279009&fulltextType=RA&fileId=S0963180113000911
    One thing is for certain is it is not a sure-fire, guaranteed way of increasing organ availability and in some situations might actually decrease it. If the basic infrastructure for optimizing ‘opt in’ donations and health promotion and education about altruistic donation are not working well, ‘opt out’ legislation won’t help as a stand alone.

  23. avatar
    Aleksandros Ho Megas

    It is in a weird way funny to see so many people here talking passionately about how organ donating should be mandatory, without really knowing what donating really means.

  24. avatar
    Robert W. Vagabond-Nomad

    Of course compulsory. Most people are okay with being donors but simply can’t be bothered to go through the paperwork.
    It should be the other way around; if you have any objections you must make an effort to opt out.

    (and if it were up to me, those that refuse being a donors shouldn’t be allowed to receive donor-organs either).

  25. avatar
    Bipul Mohanto

    In legal society what we call black market, everyday, every year millions dollar business are going on of human organ. When any organ is unavailable in market, people look for that in black market. Now question is, where does the same organ come to the black market? Of course it came from any other human body. It is a mafia syndicate as the business is very profitable and government does not get any tax money from it at all, that is the loss of government indeed. Black money, black market all are enforcing other crimes and just empowering underground. Now if government makes it compulsory for every citizen and do enough marketing to inspire people, one side it will stop illegal business and other side it will save millions life in a very cheap price. Due to some superstitious we still not motivated to donate organs after death where they of course will decompose either in soil or burnt in fire, so why not we will inspire to give that organ some more years to live in other peoples body, that is indirectly the living of ours on this earth of course. Say yes……………..

  26. avatar

    Just make it easy for people to register as donors.
    In school, at the university registration office, at the hospital reception, at the clinic, at the pharmacy, at the shopping mall, at the rock concert, at the sports events.
    There are tons of places where a person will be receptive to register and will register.
    I do not agree with compulsory things. Compulsory is not a EU trait!

  27. avatar
    Helena Feio

    That’s how it works in Portugal. Unless you leave a valid document where you say you don’t want to give your organs.

    • avatar
      Claudia Gata

      Yes I know your RENNDA., I often visit Portugal. As being a tourist, this law doesn´t get me. I don´t like opt out, my body is mne, in Germany we have opt in, thats much better. My body doesn´t belong to the state, even when I´m dying

  28. avatar
    George Papadache

    No. People have the right to make their decision about their bodies. I am in, but wouldn’t force anyone

    • avatar
      Claudia Gata

      Poor people in Portugal, I love this country, but not your opt out law. Maybe I will move to Portugal, I don´t will refuse in RENNDA, even I don´t want to be donor. can´t say yes to organ donation, I also don´t say no, I want to be neutral. In Germany that´s no problem, f you don´t say yes, nothing bad will happen to you.

  29. avatar
    Paul Gordon Bellshaw

    No, some people have religious beliefs that mean they should ideally leave this world in one piece. I don’t share that view but to make something like this compulsory is not fair. I think it should be assumed you will be a donor and have an opt out system that is clearly explained.

  30. avatar
    Costin Halaicu

    Nothing should be compulsory. It is a desirable social behavior, so it should be facilitated and encouraged, but nobody should be forced. Compulsion is not in the same boat with freedom.

  31. avatar
    Claudia Gata

    opt in must be in all EU Nations, no one should be forced to be an replacement part store

  32. avatar
    Aleksandros Ho Megas

    It is in a weird way funny to see so many people here talking passionately about how organ donating should be mandatory, without really knowing what donating really means.

    To answer the question. NO!
    Each person own his/her own body absolutely and independently!!!

    PS: It is very indicative how only few days ago the question was on this same subject posted here asking if organ “donating” should be considered automatic if person does not “opt out”; and now the question is if organ “donating” should be compulsory.
    Totalitarianism much?!

  33. avatar

    Of course people should be given the right to choose whether they want to donate or not.but i think the issue should be discussed in schools and then children grow up with the idea that it is an option, and discuss it with their families to be aware of their parents choices\ wishes and not to leave it till someone dies.if your wishes are made clear to your next of kin before you die, then there will be no problem regarding organ donation. But it must be discussed openly and frankly . I am in favour of it, and cannot understand why anyone would deprive someone else the chance to live after their death.obviously there are those who are against it on religious grounds or feel its wrong for some other reason, then that’s their choice, but the majority could help thousands of people have a better quality of life.but discussion is the key.

  34. avatar
    Gio Cruz

    Leave it up to the individual countries. It’s none of Europe’s business.

  35. avatar
    Dave Dillon

    I have no need for them when i am gone, so if any of my organs gives somebody a new lease of life, then they are welcome to them. But time is a major factor in transplantation, so an opt out system would give so many more people a life and not a death sentence. Go visit a dialysis ward first, then make a comment if it should or should not be a European directive….

  36. avatar
    Tina Clark

    My worry is thst money talks.poor die more and im guessing rich will get there parts. Wherever money involved there is corruption.
    But yes lean to yes..

  37. avatar

    NO! Teach people the social benefits of being an organ donor and let them decide. Make it easy for people to register as organ donors. Don’t sneak up on people with default registrations!

  38. avatar
    Nando Aidos

    NO! Teach people the social benefits of being an organ donor and let them decide. Make it easy for people to register as organ donors. Don’t sneak up on people with default registrations!

  39. avatar
    Popa Victor Tudor

    The internal organs are prelevated when the human body is still alive! Organs from a corpse are no suitable for transplant! Then the debate is: who decide when the human is dead and wich are the cause! Wich are the rules and the persons who can really decide when the brain is dead? Medical and moral! In the wild capitalism, when the money are the main value, do you have trust in to medical advice, who do tratament childs with large amount of money, for example? Wich is first value for MD, the money or human being? Think twice! Everyone be automatically registered as organ donors unless they ‘opt-out’ is the worst ideea I ever heard. I will not be ever agree with that!

    • avatar

      Not true at all, they don’t even know you are an organ donor until after you are dead most of the time

  40. avatar
    Ferenc Lázár

    Definitely NO! It is not the centralized European council to dictate such matters, unless is a dictatorship like the Soviet Union was..

  41. avatar
    Aleksandros Ho Megas

    It is in a weird way funny to see so many people here talking passionately about how organ donating should be mandatory, without really knowing what donating really means.

    To answer the question. NO!
    Each person own his/her own body absolutely and independently!!!

    PS: Why are You repeating some questions over and over? Is it in order to “break” those who disagree with You so they don’t participate and then create false agreement?

  42. avatar
    Paul Gordon Bellshaw

    Yes it should be an opt out process but the opt out should be made very easily available and properly advertised regularly so everyone knows their options. Where the procedures are available to let someone die because of uncertainty over their donor status would be a failing.

  43. avatar
    Andreia Fonseca

    that has already been like this in Portugal and the results show a higher transplant rate and survival

  44. avatar
    Noel Bagnall

    I’m British and would be very proud if Alextsipras was the leader for weak Britain as Cameron his weak he would lick merkels feet if told to the eu is a club for the few Germany and France say no or u will be in debt for ever and ever a blind man can see this good luck Greece

  45. avatar
    Ariste Arvanitides

    NO, and no guillotines either! Somewhere people have gotten on an evil track. Some people who were registered doners were not kept alove so others could have their organs. Enough, already. Anyone that wants to be an organ donnor, or give blood is free to do so, nothing should be assumed.

  46. avatar

    Yes, an opt-out approach would be far better. It’s introduction should be combined with a widespread information campaign on organ donation. And the option to opt-out should be as easy as possible (paper note in wallet, flag on one’s electronic health card, relative as witness etc.). It would extend lives and alleviate suffering on a large scale.

    To everyone who argues this goes against personal autonomy:
    Autonomy is preserved, since anyone can easily object.
    Presumed consent just means that the default assumption is the one that will benefit our fellow human beings most.

  47. avatar
    Radoslav S. Bozov (@Radobozov)

    In the field of biomedical ethics and science, genome ownership, as a derivative of natural selection process through the unity of haploids is to be solely determined based on the relative space of occupational individuals. The implementation of an opt out method for harvesting organs is therefore considered illegal accordingly to natural laws. This is to specify that any organization aiming to implement such rule based on prejudice and industrial field of the medical domain shell be accountable under the Superior Royal Court within legislative procedures of the Superior European Court system.

    We are determined to identify reasons behind rational thinking of possible behavioral agendas of groups of populations and individuals leading towards organ failure and furthermore advance scientific processes that will prevent the emergence of shortage of organ transplanting ‘economy’.
    In God We Trust

  48. avatar

    My body belongs to me. It is not the property of the State.

    If I carry a donor card, I have given consent for my organs to be re-cycled if that is useful to others. My relatives should not be able to overrule that, any more than the State should presume to use my body without my permission.

    The solution is not to presume consent – that is the way of totalitarianism.

    We should encourage people to put themselves on a donor register by publicising the scheme in dentists’ & doctors’ surgeries, & in hospitals. We should foster discussion of the topic in schools or at public events. But if anyone wishes to be buried or burned in possession of a full complement of body parts, that is their last right.

  49. avatar
    John Mathers

    When I die I chose to be frozen using the science of cryonics so I will not be donating any of my organs, my body is mine and I need it as I truly believe cryonics will restore me to life again in the future, I love life and chose it.

  50. avatar

    If you won’t donate your organs you and the rest of your family shouldn’t be allowed to receive an organ

    • avatar
      Steve palmer

      That is perfectly fair!
      Organ Donors will receive if they ever get sick, and non-donors are saying they do not want to receive (opting-out of receiving) if they ever get sick. Why should someone choosing to be a non-donor receive an organ if they get sick. Give and you shall receive, OR ..dont give amd you sure as hell wont get!, its up to you!

  51. avatar
    james pascoe

    who could so callous as to not save someones life if they should come to an untimely end? *(two tine organ recipient). heart-2005, kidney-(living donor) 2010.

  52. avatar


  53. avatar

    i dont think that organ transplant should not take place because they are damaging there own life by smoking and we dont if they will do the same to the new one

  54. avatar
    Van Herk

    NO ! Nobody has to be an esclave of the stock exchanges and the dirty killing pharmaceutical industry ! Being a Human Being is a Natural Product, not a DollarBiljet.

  55. avatar
    Nando Aidos

    No!!! Educate people on the value of their organs to others, and let them decide. THAT is the way to go.

  56. avatar

    NO!!! Educate people on the value of their organs to others, and let them decide. THAT is the way to go. And this topic could be part of school education.
    Education is the key,
    and not regulation!

  57. avatar
    Wendy Harris

    No, the rich cannot be trusted not to harvest the organs of the poor for their own needs. Money can buy anything, even the convenient death of a suitable donor. People should make it clear to their families if they wish to donate or carry donor cards. All of our immortal atoms belong to the universe and not to each other is my own belief. The way to go is to continuing creating organs from stem cells.

  58. avatar
    Gatis Gailitis

    Perhaps in countries with demographic problems it should be considered but it cannot be enforced. I’m a donor too but by choice and o wouldn’t want it any other way.

  59. avatar
    Σαντυ Μπαλμπαγάδη

    Everything is a choice.If anyone wants to be a doner he or she should tell it to their family.It depends also in religion,beliefs and how comfortable you feel with that.It’s not democratic to force people to give their organs.And EE has no saying in this issues.Everybody has the right to decide for their body.

  60. avatar
    Marijus Stasiulis

    If everybody was organ donor, then there was less demand for organs and i doubt that there would be “organ harvest”.

  61. avatar
    Marijus Stasiulis

    If everybody was organ donor, then there was less demand for organs and i doubt that there would be “organ harvest”.

  62. avatar

    i have a debate about this topic tomorrow

  63. avatar

    Yes, it is not hard to opt out if you have an ideological problem with organ donation. The problem with an opt in system is that people forget to do it even if they have to issue with having their organs donated. People are far less likely to forget to opt out than to opt in.

  64. avatar
    Rebeca Muñoz

    It is a difficult question, I think maybe yes because everyone is dying because of people not donating organs and that could be avery good solution.

    • avatar
      james pascoe

      yes! your organs could save the lives of many. why would not grant the gift of life after you are gone?

  65. avatar

    Organ donation should be left as an individual choice. People have their own set of beliefs and others should respect that.
    I have been in a work situation recently where I was asked if I agreed with organ donation. I said that my belief is that a person should be taken to the grave whole. One of my colleagues was out raged with me and got funny with me over my belief. Perhaps they should not have asked the question in the first instance if they did not want my personal view.
    Life is about choices and I respect others for their belief and they should respect mine.

  66. avatar

    Don\t worry harvesting idiots, we are on the verge of regenerating tissues. Don\t ask how that works, but behave to preserve your stem cells so that we could be able to graft you back, if you would like to live long that much, and suffer through. The grand question, whether there is a soul or not, yes, there is a soul! What it is? It is light living within carbon entangled systems, including organs. The problem of the business with organs and on, is a problem of ethics! Because many scientists don\t give a dam about ethics, their soul will burn out in eternity! Physics of life is conquered by experiments. We know that people who receive organs from good people, tend to transform into right behavior. And people\s organs who tend to live outside of the ethics law, translate energy to receivers in a way that makes them kind of evil. People who harvest organs on purpose, will have their soul harvested, and live in agony their end days! Plain advise, live right, and your organs will not fail! Each stem cell organ bio clock is capable of re setting its own time! All you have to do is, give it a chance by correct input output bio mass, of time, and space! And fear no death~!

  67. avatar
    prime hospital

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    Waiting for your responds….

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