Presumed Consent for Organ Donation
The UK operates an opt-in system for organ donation where people have to make their wishes known by registering their details on the NHS Organ Donation Register, carrying a donor card or telling their family. If a person dies the register is check for their details and regardless of whether they have registered or not their relatives are asked for their agreement before organs are removed.
However the need for donated organs far exceeds the supply and whilst many people are positive towards the idea of donating their organs, only a relatively small number have actively registered to do so.
In his July 2007 Chief Medical Officer’s annual report Sir Liam Donaldson recommended the UK changed to a system of presumed consent in an attempt to increase the number of available organs for donation. The opt-out system would mean health professionals would be able to assume everyone had consented to donating their organs unless they had specifically registered their desire not to become an organ donor.
If UK organ donation moved to an opt-out system there would be safeguards to make sure that anyone who did not wish to donate organs could easily make their wishes know. Any relatives who feel particularly strongly about donating organs would also have their views respected in “special circumstances”.
The opt-out system is used in many other European countries however there are concerns that it can cause major distress for relatives who can feel that they have not been consulted. It is also worth remembering that due to the timescale involved in making decisions it will not always be possible to contact a next of kin in time. In these situations there will need to be strict guidelines to ensure the wishes of the deceased person and their family are followed.
The View from The Patients Association
The Patients Association is aware of the critical shortage of organs available for transplant and the devastating effect this shortage has on those awaiting transplant surgery. We are also concerned about the increasing number of desperate patients traveling abroad for transplants, often to developing countries with less rigorous regulations and ethics.
The UK must look at ways of increasing the number of people on the NHS Organ Donation Register and The Patients Association acknowledges the most obvious and rapid way of doing this is to operate an opt-out system. We agree with Sir Liam that action should be taken and appreciate that it can be challenging for clinicians not to know exactly what their patient would have wanted to happen following their death. We also understand that the number of people carrying organ donor cards is not representative of those who would be willing to donate an organ.
However it is vital to remember that the decision to register as an organ donor is an intensely private one and needs careful consideration and consultation with family members. People need to be encouraged to make a choice regarding organ donation but those with a strong desire not to donate should still have the right to easily make this know. In this way we are not satisfied that the opt-out system works for everyone. In an emergency situation the right to opt-out may not be sufficient if organs are transplanted before a family can alert the clinical team to the fact that a patient did not wish to be a donor.
The Patients Association believes that the key to increasing organ donors is to raise public awareness and access to the register rather than imposing an opt-out system. A public campaign would highlight the shortage of donors and allow people to register a personal choice in an easily accessible forum.
An opt-out system places a hugely private decision in the hands of the Government. We believe with increased awareness those who choose to make this “gift” will also choose to make it known.
