Monday, November 14, 2011

My Organ Donation Article in 'The Times'

The proposals by the Welsh Government to change the system of organ donation in Wales is interesting from a 'policy', an ethical, and a 'constitutional' perspective. During the discussions so far, I have steered clear of all except the policy issues, and whether a change to 'presumed consent' would be effective. Tomorrow I'm meeting a constitutional lawyer so that I can understand properly the dangers of legal challenge to the Welsh Government proposals. The debate about opt-out will inevitably feature on this blog from time to time over the next two years. In the meantime, I'll share with you the article I wrote for the Times last Friday. It's 500 words long.

This week the Welsh Government launched a consultation paper on proposals for legislation on organ donation. The effect of the legislation, if passed, would be to change fundamentally the system of organ donation in Wales. Rather than an opt-in system, Wales would have an opt-out system. An absence of objection would be taken as considered approval, an assumption that seems ethically improper to many of us. There seems to be compelling evidence that more organs would become available for transplant before moving forward with such a drastic step.

There is a desperate need for more organs to be donated. However, there is no firm evidence that a change to presumed consent would make any difference- and some evidence that it may do harm. There are several organisations that support the Welsh Government's proposals, which is surprising because of the weakness of supporting evidence.

During the past decade I have taken an interest in this issue, knowing of people needing transplants and through campaigning for renal dialysis provision. Throughout that period, supporters of presumed consent have championed Spain as an exemplar.

It is true that organ donation has improved significantly in Spain over the past 30 years, but closer examination tells a different story. Presumed consent legislation was enacted in 1979, on the assumption that it would increase organ donation. However, in 1980 a royal decree stated that objection could be stated in any way, without formal procedures. In practice, Spanish law is only theoretical presumed consent. There is no opt-out register. A donor's wishes are established by discussion with next of kin.

The level of organ donation in Spain did not change for ten years until, in 1989, the Government made several key policy changes that led to a gradual increase to the outstandingly good performance of today. Nothing to do with presumed consent. Now the favoured exemplar has changed to Belgium.

During the final year of the past Labour Government, Gordon Brown began advocating presumed consent, and he established an organ donation task force. I can do no better than quote from its conclusions: "The more the task force examined the evidence, the less obvious the benefit, and more multifaceted and multidimensional the issue of donor numbers was revealed to be.

"The task force reached a clear consensus in their recommendations that an opt-out system should not be introduced." A similar conclusion was arrived at by a cross-party Welsh Assembly committee.

There is a desperate need to increase the availability of organ donors. We need to learn from international experience where great success has been achieved, such as the United States and Spain. People are suffering and people are dying. The UK needs a comprehensive transplant coordination strategy. It does not need an ill-though-through change in the law that appears superficially attractive but remains unproven.


Anonymous said...

The main objection that occurs to me is - do they include only people who live in Wales in presumed consent planning, or would it be for anyone who was in Wales at the time? And if so, how would that be enforced and policed?

For example, I live in England (which would still have an opt-in system) and commute to a university in Wales to work. If there were a car crash on on my way to work and I were fatally injured - although obviously I hope it doesn't happen - would the fact that I have not opted out of organ donation, on account of the fact that I do not have to in England, mean my organs might still be harvested in a hurry before someone realized the mistake?

A theoretical situation perhaps, but it strikes me as a possible flaw in a way that it would not be in Spain (as one sovereign country). I don't know whether there is anything on that, but I would be interested to find out.

Glyn Davies said...

Dr Huw - I do not think any of this has been thought through. Its one of the poorest drafted 'white papers' I've ever seen. In face, its not a white paper. Its a sort of loose ideas consultation paper.

Paul said...

In your article you say Spain implemented "several key policy changes". What were they? and if they were so effective shouldnt we be trying to do the same?