8 Nov 2011

Welsh consult on organ donation opt-out

The Welsh Assembly is considering creating an organ donor system which presumes consent for organ donation unless the person opted out in their lifetime. Channel 4 News looks at the ethical questions.

The Welsh government announces plans for an opt-out organ donor system (Reuters)

Under the proposals, the current system whereby people opt in to organ donation by signing the organ donor registers, would change to one where consent would be presumed unless the person had indicated they did not want to donate their organs.

The Welsh government said last year 51 people in Wales died while on the waiting list or following removal from the waiting list due to a deterioration in their health.

One of the main critics of the proposed legislation, the Archbishop of Wales Dr Barry Morgan, is concerned the law would consider peoples’ organs as “assets of the state” instead of them being donated voluntarily.

Professor John Harris, professor of bio-ethics at the University of Manchester, who supports the change, told Channel 4 News this attitude is unhelpful as inevitably people’s inertia means they do not sign up to organ donation registers.

He points to European examples where an opt-in arrangement has had a radical effect on organ donation: “In Spain, which admittedly has a different culture regarding medicine and medical ethics, the introduction of the opt-out donation system has meant the shortage of donors has been entirely eliminated and the country is now a net exporter of organs.”

Organ trafficking

The British Humanist Society also welcomed the move.

A spokeswoman told Channel 4 News: “The “soft system” of presumed consent which is being proposed in Wales accommodates the wishes of individuals and their family members who do not wish to donate organs, while at the same time has the potential profoundly to benefit society as a whole if it increases the availability of organs.

“In turn, many lives would be saved, and the practice of organ trafficking would be greatly reduced. Ideally, we would like to see such a system implemented throughout the UK, if the evidence shows that it is effective in saving lives while protecting individual autonomy.”

Opponents of the change say the opt-out register would erode trust or “create suspicion” in the system, in the words of Glyn Davies, MP for Montgomeryshire.

The new rules would only apply to “people aged 18 or over who live in Wales, and who have had the opportunity to make an objection to donation of their organs and tissues in the event of their death”, and who die in Wales.

Professor Harris thinks this would be approved of across the border: “The Welsh assurance that only people who live and die in Wales would be subject to the new system is a way of reassuring the mean-spirited English that they’re safe from opt-out – but, of course, they’re less safe overall.”

Families will be involved

The proposals aim to ensure that the family of the dead person is involved in decisions about their organs, but it stresses that “the wishes of the deceased are given primacy”.

It is proposed that doctors “sensitively encourage relatives to accept the deceased’s wishes, whilst making it clear that that the relatives do not have the right to override those wishes”.

Professor Harris said he welcomed this change: “Why would a decent, well-meaning person want to stop someone from getting a life-saving operation? Grieving is bad but causing grief is worse.”

He also thinks that concerns that a body should be buried intact are unimportant when someone’s life is at stake: “”The idea that some people think that their body should remain intact when everyone knows the truism ‘ashes to ashes, dust to dust’ beggars belief.

“We know that unless transplanted, our organs will go to waste after death and what will surely turn to ashes are the hopes of others for a life-saving transplant.”