Yes
Dr Mike Knapton
Director of prevention and care, British Heart Foundation

The current situation is desperate. Last year 1,000 people died having waited in vain for a transplant. There are 8,000 people on the waiting list and the shortfall in the number of organs available, at a conservative estimate, is 50 per cent. We believe that an opt-out system would increase the number of people who donate.

We know that at least 65 per cent of people, when asked, support the idea of donating their organs. A large number of the others support organ donation in principle but haven't thought about whether they would donate. However, only 25 per cent of people are on the organ donation register. That is 15 million people, but still fewer than half of those who say they would be prepared to donate. We think an opt-out register would mean that the people who don't get round to signing the form would get their wishes and their organs would be available for someone who needed them.

Why people don't sign up is a good question. Young people don't think they're likely to die and say: ‘It can wait.' But there are also several myths that are barriers to donation. The first is that doctors will take your organs out if you're not dead. This is false. There is also a notion that doctors will make less effort to keep you alive if you're an organ donor. Again, this is false. The last is that only young organs are any good. It's untrue: nearly half of UK organs are donated by people over 50 and we can transplant the organs of people in their eighties. The key issues include someone's health and tissue compatibility rather than age. We need a public debate to help to remove these fears. An opt-out register would make organ donation more commonplace and so help to dispel these myths.

“We also need to improve trust in the medical system. It is critical to the relationship between health professionals and members of the public. An opt-out scheme does not mean that the sensitive conversation between a doctor and the patient's family about donating organs doesn't happen. Families should still have the final say.

We would back the opt-out system only if there was public support - at present 60 per cent of people are in favour - and safeguards to protect vulnerable groups and the views of those who chose to opt out.

Increasing organ donation will not happen by changing one aspect of the scheme in isolation. An opt-out scheme alone is not sufficient. We also support the recommendations of the organ donation task force, published in January, which highlighted other measures, such as donor identification, co-ordination and organ retrieval, that will improve the number of successful transplantations.

It is true that discussing a change in the law could take years. However, the debate around presumed consent will raise awareness of the importance of organ donation and address the public's attitude towards it. What is at stake is the lives of patients who, without a transplant, have no future.

No
Imogen Shillito
Director of information and education, British Liver Trust

The main reason we don't support a change in the law is that it would involve a protracted public ethical debate and the drawing up of legislation. All of which takes time that patients who are on the waiting list for a transplant don't have.

If we pin all our hopes on this change in the law delivering the boost in organs we need, it will distract the NHS from implementing more immediate changes that could be more effective. It would leave clinicians uncertain about whether to focus on boosting donation within the current law or wait for legislation.

There is a desperate shortage of organs available for transplant - the UK has one of the worst transplant rates in Europe. With no dialysis for liver disease, many people die on the waiting list. There are also many people who are not on the transplant list because there is no hope of them getting an organ. If there were more organs available, many of those people would get their second chance at life.

We fully support measures to increase organ donation rates but we have no confidence that starting a process to change the law would actually improve the situation. There are many improvements that can be made within the current law. We need a package of practical measures to increase donation rates rather than just one high-level change. The organ donation task force commissioned by the Department of Health made 14 main recommendations that we would like to see implemented without delay.

The task force recommended mandatory training for all clinicians involved in the care of potential donors and their relatives, to support them in a highly sensitive and emotional task. Gaining consent from dying patients and bereaved families is incredibly difficult, particularly, as is often the case, when a potential donor was a healthy person a few hours earlier and, perhaps, has been involved in a road accident or other health catastrophe.

There are other measures that are important, including a desperate need for more transplant co-ordinators and retrieval teams. Publication of hospitals' donation rates would help to identify which hospitals are doing well and share best practice across the NHS, driving up donation rates overall. Many countries have excellent donation rates without presumed consent, and we need to learn from their experience. Practical measures rather than a move to a paternalistic era, where the consent of people is taken for granted, is what we need now.

Surveys have shown very high public support for organ donation - about 90 per cent - so consent is a red herring as a barrier to donation. This high public support needs to be translated into enabling people to make organs available. If a family does not get asked about donation, it is a real tragedy, not only for patients on the waiting list for transplant, but for families who might get some comfort from knowing that their loved one has saved another life.

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