The ins and outs of organ donation
Elliot Bidgood, 16 July 2013
Late last week it was announced that NHS Blood and Transplant (NHSBT), the body that deals with organ donations, is exploring barring relatives of registered organ donors from overriding donor’s wishes in the event of their deaths – currently, this happens in at least 13% of cases. This announcement of course comes on the heels of a landmark law passed the previous week by the Welsh Assembly that makes organ donation an ‘opt-out’ (presumed consent) matter rather than an ‘opt-in’ one as at current, the first of its kind in the UK.
The Welsh are modelling their approach in part on Spain’s opt-out policy, while NHSBT’s attempt to reduce objections from relatives may be inspired by similar policies in America. Another idea being mooted by the NHSBT is a ‘give and take’ policy on the NHS, in which people who are registered as donors should get preferential placement on waiting lists should they themselves need a transplant, in order to create reciprocity and a non-financial incentive for donation – this is already practice in Israel and Singapore.
About a third of Britain’s population (19 million) are signed up as donors, though this does not remedy the problem, as most people will not die in circumstances that allow their organs to be used – they usually have to die in hospital in order for their organs to be eligible and meet certain other criteria, limiting the number of people who can give to about 5,000 a year. As a result, organs are inevitably subject to heavy rationing, as a Civitas publication by Dr Heinz Redwood once noted, and the NHSBT hopes to boost the number of donors to at least 27 million, so as to increase the potential base. Meanwhile at current, around 1,000 people requiring transplants die each year (2-3 a day) due to a lack of available organs.
In light of such statistics, the clamour for legal changes is understandable. However, while the basic plans of both the Welsh government and the NHSBT are solid, I would also caution that sensitivity remains crucial. One of the main lessons learnt from the Spanish approach has been that the presence of well-trained teams of transplant co-ordinators, working closely with families to assuage and address their concerns, was vital and held down objections. Sensitivity is particularly important in light of the objections of some religious groups and the NHSBT’s own warnings that a failure to tackle these issues adequately could damage public trust in the donation process and the NHS. While acting to save lives is laudable and vital, we would do well to tread carefully and follow proven examples as we do so.
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