Should we have an opt-out organ donation system?

PM Gordon Brown wants everyone to be listed on the organ donor register – with an opt-out option for anyone who doesn’t want to be included. Is this right?

Yes
The gap between the number of organs available and the number of people needing a transplant is growing. More than 9000 people in the UK currently need a transplant and the average waiting time for an adult kidney transplant is 841 days. ‘Not enough of us have signed up to the organ donor register, and the main reason is complacency,’ says Dr Tony Calland, chairman of the British Medical Association (BMA) Medical Ethics Committee. ‘If you asked people on the street, you’d find they support organ donation – they just haven’t got round to signing up.’ In 40 per cent of cases, relatives don’t consent to organ donation because they don’t know what their family member would have wanted, so they decline to be on the safe side.
So the government, in consultation with a number of medical organisations, has proposed a solution: presumed consent. If the Bill was passed, the names of everyone in the UK aged 16 and over would automatically be put on the organ donor register and the onus would be on the individual to request that their name be taken off it. ‘The BMA supports “soft” presumed consent,’ says Dr Calland. ‘This means that if your family has particularly strong objections, they can stop a donation going ahead.’
An independent organ donation task force carried out a special enquiry into presumed consent and unanimously voted against it, saying it might destroy the trust that patients have in doctors. But Dr Calland points out that medical care and organ donation teams are entirely separate. ‘The doctors caring for someone are in no way affiliated to organ donation co-ordinators,’ he says.
A 2007 YouGov survey showed that 64 per cent of respondents would support soft presumed consent; however, before the law is changed, the BMA wants to conduct a substantial public education process to ensure that all of us are aware of our choices.

No
The pool of organ donors within the UK is small for positive reasons, according to John Evans, joint president of the British Organ Donor Society (BODY). We have a low level of road-traffic accidents (a common source of organ donors in other countries), anti-gun and -knife laws and excellent intensive care units. And making the transition to presumed consent could be a bigger shift than we’re prepared for. ‘Many doctors and nurses in intensive care units lack the contacts and resources to move quickly and suggest organ donation to families,’ says Evans.
BODY believes people would be driven to opt out because they dislike the principle of presumed consent. ‘There is not a shred of evidence that it would increase the number of organ donors in the UK,’ says Evans. ‘The basic premise that donor numbers will increase with this method has become folklore when, in fact, numbers may actually decrease.’ Evans also believes that presumed consent would undermine the idea of organ donation being a gift, and fears that some people might worry that every last effort would not be made to save the patient’s life if attention had already switched to the possibility of organ donation after death.
‘I believe the best way to increase organ donation is by improving the medical infrastructure and educating young people as part of their school curriculum about the issues surrounding donation. We all need to be made aware how being an organ donor can help to change – and save – lives,’ adds Evans.

Healthy verdict
Organ donation is a complex subject, but it’s clear that major changes need to be made to ensure an increase in donations. Healthy believes that the current shortfall in organ donations is too pressing an issue to rely purely on public education to increase donor numbers. A system of soft presumed consent would mean that those who support organ donation but have previously failed to sign up to the register no longer have to remember to do so. As long as a donor’s family maintains the right to veto organ donation if they think it’s inappropriate, presumed-consent organ donation could be very successful.

Words: Hannah Fox