Leading Article: There can be no apartheid within the health service

THE RACIST offer to donate a life-saving organ presents an acute ethical dilemma. There is a tremendous shortage of transplant organs, and the medical profession is bound by the Hippocratic Oath to save lives wherever possible. If the Northern General hospital in Sheffield had refused to take the controversial kidney with its odious terms and conditions attached, they may have been refusing somebody the chance of life. But by accepting this organ, and passing on the wishes of the donor's relatives, the hospital and the transplant service have introduced apartheid into the National Health Service, and institutionalised a racist act of the most despicable kind. For by limiting the recipients of this kidney to white people, the hospital was endorsing the potential denial of life to a black or Asian person.

Allowing prejudice to creep into organ donation - however desperate the need for more organs - is a perilous path to follow. For many families who have just watched a loved one die, organ donation is a brave and difficult decision to take. In their grief, a family whose teenage child has been killed by a drunk driver can be reluctant to see their child's liver given to an alcoholic. Rightly, doctors seek to dissuade donor's relatives from making these restrictions. Even apparently reasonable preferences go against the grain of the altruism of the decision to donate organs. This should be a decision to save life, wherever possible, and regardless of race, colour, creed, or any other arbitrary reason. To do otherwise is not, as some may claim, to exercise free choice. It is to embrace a culture of bigotry where a patient's chances of receiving an organ could depend on their beliefs, sexuality or colour.

The prevention of this practice cannot be left up to doctors alone. Their duty to save life puts them in an extremely difficult position if it is either legally or practically feasible to save a life by accepting an organ - any organ, even one with conditions attached. The Government must therefore act to ensure that it is illegal and impossible for any conditions or preferences to be attached to donated organs. What is not needed, however, is a long and protracted inquiry into this case and the transplant service before any action is taken. Questions do certainly need to be asked, but they should be answered quickly. The overriding aim must be to act soon to prevent the attachment of conditions to organs as soon as possible. Frank Dobson's inquiry into this case should be swift and conclusive in its condemnation of the institutional acceptance of racism. And he must make it clear in no uncertain terms what constitutes unacceptable practice.

Disallowing the donation of organs with conditions attached is not, however, risk-free. The result could be that there are even fewer much-needed organs to be spread thinly round the thousands of patients waiting for a transplant. Last year, 200 people died while waiting for a new organ. In the face of life and death, even this dreadful bigotry pales.

But there are alternative ways to save life. One of the main reasons behind the shortage of organ donors is the lack of donor cards carried. But in some countries in continental Europe people are assumed to be organ donors unless they have "opted-out", freeing up a large number of organs. It is timely that the medical profession will today, at the BMA conference in Belfast, debate whether an "opt-out" scheme should be introduced to this country. We hope they support such a move, for this is the true solution to the shortage of organs, one which will ensure no more hospitals or doctors are caught in the dilemma that faced the Northern General. Mr Dobson, having banned the attachment of conditions to organ donations, should move swiftly to instigate the "opt-out" system, thereby curing the cause of this particular problem, as well as the symptoms.