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.
