John Humphrys - Organ Donation: Opt In or Opt Out?

December 13, 2017, 4:47 PM UTC

The government has launched a consultation process to see whether the system of organ donation should be changed. People who want to allow their organs to be used for transplants after their death have to sign on to a donor register or, if they forget to do so, hope their families will agree to it as soon as they have died. The government is proposing that, instead, there should be a system of ‘presumed consent’. It means that unless someone has explicitly said they don’t want their organs donated, doctors can use them, even against the wishes of the family. The aim of the change is to increase the number of organs available for transplant. But some sceptics question its ethics and anyway, they say, it wouldn’t work. Who’s right?

There are about 6,500 people in the UK as a whole waiting for organ transplants. Each year several hundred die before the desperately needed organ has become available. The government wants to reduce that. The health secretary, Jeremy Hunt, said: ‘Every day, three people die for want of a transplant, which is why our historic plans to transform the way organ donation works are so important’.

Mr Hunt believes that the system of ‘opting in’ to organ donation is not working well enough even though the number of people signing on to the register has increased substantially in the last ten years. In 2007 there were 14.1 million people on the register and there are now 23.6 million. But the number of actual donors from the register, although rising from 793 in 2007 to 1413 ten years later, is still small compared with the demand. The problem, as the government sees it, is that the percentage of families agreeing to the use of their deceased relatives’ organs when those relatives had not signed the register, has stuck at between 60% and 65% and this is the reason it believes supply lags demand.

Wales has already changed the way organ donation works to an ‘opt-out’ system of presumed consent and Scotland is on its way to doing so too. Mr Hunt’s consultation concerns England. It asks the question: ‘If someone has died and they have not opted out of organ donation, should their family be able to make the final decision?’ Or, to put it another way, should the state rather than the family be able to take the final decision in cases where someone who has died has not explicitly stated they don’t want their organs to be donated?

Judy O’Sullivan of the British Heart Foundation backs the change. There are 249 people waiting for heart transplants and she argues that although the opt-out system is not a panacea and needs to be combined with other measures, evidence from Belgium and Croatia suggests it helps.

But others are highly sceptical. Professor Chris Rudge, a retired kidney transplant surgeon and former head of the UK’s transplant services, said: ‘The key question is “Will it work? Will it make a difference?” And if the answer is yes, then that would be very good. But if the answer is no, then I question why we are going down this route. The only evidence that I have seen is that it won’t make any difference and it is not the answer to the problem, but there is a risk that it may make things worse.’

The evidence so far from Wales is that it has had no effect on the number of organs available and may actually have reduced the number, though it may be too soon to draw conclusions. But whether or not the change would be effective, there is another objection: that it is a step too far for the state to presume rights over a dead person’s body.

Professor John Faber, the former president of the British Transplantation Society, would love everyone to sign the register but argues that we should be alarmed ‘once the state starts relieving you of your obligations’ by passing a law giving it rights over the use of your body parts simply because you hadn’t been bothered to decide the issue yourself when alive. In any case, he says, there are better means of increasing the number of organs available for transplant.

He argues that over the last twenty years or so Spain has managed to increase the proportion of families agreeing to the use of their deceased relatives’ organs to around 85% through a campaign of public education and by careful targeting of potential donors in hospital. Crucially (in his view) Spain has managed to increase the number of organs available without bypassing families, as the new British government proposal might well end up doing. Indeed in Spain families can even override the wishes of their deceased relative that their organs be donated.

Others have raised a quite different moral issue to that of whether families or the state should have the final say when those who have died have left no instruction. They suggest that the best way to raise the number of donated organs would be to change the law so that before anyone could be given a transplant they would need to have signed the register making their own organs available. That would quickly raise the numbers signing up, they argue, and would be a perfectly legitimate quid pro quo.

What’s your view? The government’s consultation asks the question whether families or the state should take the final decision on the use of a deceased person’s organs when that person has left no instruction of their own. How would you answer that question?

Let us know.

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