Saturday, November 05, 2011

A Presumtive Approach to Organ Donation

Seems that not many people are prepared to publicly oppose the introduction of 'presumed consent' for organ donation. I am. The Archbishop of Wales did too, and he was roundly condemned for it - by people who had held him up as the great oracle on other issues. I was appalled by the tone of those who criticised the Rev Barry Morgan - so much so that I am seeking a Westminster Hall debate in Parliament for MPs to consider his words. In the event that I'm drawn in the ballot, I need to begin preparing my case. This is my first brief stab at it. Feel free to challenge.

Lets get one thing clear. The great majority of us want to see more organs being made available for transplant. It will not be possible to ever reach 'enough' but the UK's performance is abysmal. To this end the Welsh Government has decided that rather than donors declaring that they want to opt-in by joining a register, it should be assumed that all of us want to donate unless we join a register to say we want to opt-out. And most people I know believe this would greatly increase the availability of donated organs. I do not - and can find no evidence to contradict.

The main reason I object to a change in the law is ethical. Seems to me ridiculous to equate absence of specific objection with considered approval. The Archbishop's objections were also based on ethics. However, we live in a world where ethical considerations are given little value, so I intend to argue my case on efficacy grounds. Changing the laqw would make no diference. It just would not work. It might even make the position worse.

We're talking about a 'soft' opt out (much is made of this) - which means that next of kin have to be asked. Actually, there is no other practical form of opt-out in civilised coutries. I think it was Brazil that tried an opt-out without next of kin approval a few decades ago, and number of organs available for donation crashed. Trust in doctors also crashed. The law was soon abandoned. So next of kin need to approve donation whichever the system. Since the donor needs to be in an ITU for donation to take place, the only difference between the systems is knowledge of the donor's intention - assuming the register is up to date. All we actually need is an accepted custom that we all tell our next of kin what we want in the event of our death. In Spain, where the levels of donation are more than twice as high as the UK, very few carry a donor card, and there is no national register. Its just that the potential donor will have discussed the issue with next of kin.

So let's look at Spain, which until recently was being held up as the the exemplar by those who want to change the law. In 1979, the law was changed to 'presumed consent'. In 1980, protections for donors had to be approved by Parliament. The levels of donation hardly changed until 1989, when a comprehensive transplant coordination system was introduced. From then on the levels of donation began to improve to today's impressive levels. The law of 'presumed consent' remains on the statute book, but is in effect defunct. We need to learn from Spain's example.

But UK Governments have a tendency to impose its will on the people. In 2008, the then Prime Minister, Gordon Brown, decided to go down the opt-out road. He established a Dep't of Health Commission to consider the issue. Shock horror, the Commission recommended against. It also recommended that a comprehensive transplant coordination system be introduced. Now this costs a bit of money, but there would be no need for the bureaucracy involved in retaining registers. It would just involve everyone making sure their next of kin knew their wishes. Actually, its as simple as that.

And there's more. In the US, a 'presumptive approach' has been adopted - and again great success has been achieved. It would need checks to ensure a 'presumptive approach' does not become any sort of coercion - but its an approach worth looking at in the UK. There is a whole lot more to this debate. Too much for a blog post. But its a start. Any comment, including challenge will be welcome. I've given my debate, if I secure it, the title of "A Presumptive Approach to Organ Donation."


Alison said...

Presumed consent assumes the state owns your body, unless you specify otherwise. It goes against basic ethical principles of autonomy.

Glyn Davies said...

Alison - agreed, but in our secular world, this argument is not strong enough. A change of law will not work. This is where the argument must be won.

bonetired said...

It is important to realise that no-one owns a body. People are merely in possession of it. This is normally, of course, the relatives and executors but might be the hospital or a coroner depending upon the circumstances. The full legal position is here.

However, my, albeit atheistic, point of view comes down to that old, but still valid, point of view described by Jeremy Bentham as "to form laws in order to create the greatest good for the greatest number". There is absolutely no doubt in my mind that the greatest good may be provided by presumed consent. To put it simply, far more people will recover from serious illness or be saved by premature death by presumed consent. Doctors are fearful - understandably - of asking relatives about organ donation in cases where no explicit consent is given.

Ice Cold in Alex said...

Sorry I've lost you somwhere - you say "The levels of donation hardly changed until 1989, when a comprehensive transplant coordination system was introduced. From then on the levels of donation began to improve to today's impressive levels. The law of 'presumed consent' remains on the statute book, but is in effect defunct. We need to learn from Spain's example.

Why is the law of 'presumed consent' as you claim defunct?

Or are you saying that a law of presumed consent as well as a comprehensive transplant coordination system is ok?

John said...

There was a TV advertisement last night, a conversation (I think) between a father, daughter and the viewer, and the message ...

... If I wish to receive I should be prepared to give (organ donation).

No politics, it might be the "Big Society" in action.

Anonymous said...

You should contact Live Life then Give Life and get their view. They are the leading UK charity campaigning for organ donation, set up and run by people who have themselves either had a transplant, or have a close family member that has or has died waiting.

Again, suggest that you google Jessica Wales and read her story.

Personally, I'm all for the changes that Wales want to introduce. Why would I need my organs once I am dead - they are only going to be burnt. And I don't see it as the state owning my body. Unless people want to keep their loved ones organs on the mantlepiece why not allow someone else to live when you have died.