Letter: Transplant consent

Sir: Dr Michael Wilks, chairman of the BMA's ethics committee (Right of Reply, 23 February) rejects my call (Comment, 19 February) for the automatic availability of cadaver organs for transplantation.

He rejects my analogy with coroner-ordered post-mortem examinations, for which consent is not required and from which there is no opting out. He rightly points out that "in addition to the very different purposes for which the organs are taken, there is the natural feeling that a patient whose heart is beating, even if artificially aided, is different from a corpse".

It is true that the purposes of post-mortem examination are different, but the issue is whether they are more urgent or important or involve a more significant public interest. Saving someone's life is prima facie at least as important and urgent and as much in the public interest as explaining a mysterious death. Of course the explanation of some mysterious deaths may reveal that a murderer is at large and apprehending him may save lives (as do organ transplants). However, the prime public interest is the same: that of protecting the public.

As to the natural feeling that beating-heart donors are different from a corpse, the answer is that they are not relevantly different if they are brain-dead, which they must be to be available as donors.

Dr Wilks expresses the fear that "interventions" such as mine might damagingly polarise feelings. Of course I hope not. But I first expressed this view publicly in 1983 and I have continued to express it publicly. My fear is that the thousands of lives that have needlessly been lost in the 16 years which it has taken the BMA to recommend change will continue to mount. An opting-out system will remain vulnerable to changes in public mood of the sort which rightly worries Dr Wilks, and also to the decisions of surviving relatives, who often refuse permission for organs to be taken even from registered donors.

Professor JOHN HARRIS

Institute of Medicine Law & Bioethics

University of Manchester

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