Change law on organ donation, doctors say
Radical solution to boost donors would compel everyone to make a choice
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Every adult in the UK would be legally required to decide whether to donate their organs after death, under a radical solution to the critical shortage of organs for transplant put forward by the country's oldest royal medical college. The ethics committee of the 500-year-old Royal College of Physicians (RCP) has called for an examination of "mandated choice" as a means of boosting the supply of organs, the shortage of which is leading to more than 1,000 avoidable deaths a year.
The development comes as the first UK-wide campaign to promote organ donation is launched today to boost the numbers on the donor register. Research shows that while 96 per cent of people said they would accept a transplant if needed, only a quarter (27 per cent) have volunteered to donate their organs after death. Almost half (45 per cent) said they would like to donate but had not got round to adding their names to the register.
Mandated choice is an approach to public policy under which people are required by law to state a choice. It is employed in Australia, where citizens are compelled to vote in parliamentary elections. The RCP's ethics committee says the same approach should be considered in organ donation. People would be required by law to answer a question on whether they would donate their organs after their death and their choice would be registered on a national database.
The RCP says the question could be put at the time that adults register to vote on the electoral roll and should have three possible answers: yes, no, or ask my relatives. The third, default option, reflects the status quo.
Details of the proposal are contained in a paper by Professor John Saunders, chair of the ethics committee, to be published in the journal Clinical Medicine next month. It builds on a report prepared by the RCP and submitted to the Government's taskforce on organ donation last year. The taskforce rejected mandated choice but only considered the policy with a yes or no answer.
Professor Saunders said: "They appear to have decided it was beyond their remit. They did not consider the third default answer of 'ask my relatives'. That would have answered most of their objections." Professor Saunders said the crisis in transplantation was so acute that radical measures were required. There are 8,067 people on the waiting list for a new kidney, heart, liver or other organ, but only 3,679 received a transplant in 2008-09. "We have a growing list of people who would be best treated by a transplant but not enough organs," he said. "Even with the best strategies for organ retrieval... there are always going to be patients who cannot get the organs they need."
Mandated choice for organ donation has been tried and abandoned in Texas and Virginia in the US in the past 20 years, but in both states it was restricted to a yes or no answer. In Virginia, a quarter of the population refused to state a preference and in Texas, where it was made a condition of obtaining a drivers' licence, 80 per cent chose not to donate their organs.
Professor Saunders said this experience showed why a third default answer – ask my relatives – was necessary. "My strong suspicion is that if you make people choose they will think there is something wrong with the choice. That is why you need an option of staying with the status quo."
The British Transplantation Society, representing transplant surgeons, said it was "supportive of looking at initiatives" to boost organ donation but added the time was not right. Keith Rigg, the president said: "It is important that the discussion of alternate approaches to consent do not deflect from the recommendations of the Organ Donation Taskforce, which aims to increase the number of organ donors by 50 per cent by 2013."
The British Medical Association, which supports presumed consent, said it was opposed. Tony Calland, chair of the BMA ethics committee said: "We would not support the kind of coercion involved in mandated choice."
A spokesman for the Department of Health said the idea of mandated choice had been rejected by the Organ Donation Taskforce. "Since the programme to implement the Taskforce's recommendations began, almost one million additional people signed up to the Organ Donor Register in the first year alone.
"This is an encouraging start and it is important that we give the Taskforce's recommendations time to work before considering changes to the legal position."
Transplants in numbers
8,067: Number of people waiting for a transplant on the "active" list.
2,435: Number on the suspended list because they are too ill or unable to receive a transplant at present.
3,679: Patients who received a transplant last year.
To join the NHS Organ Donor Register, call 0300 123 23 23 or visit www.organdonation.nhs.uk
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Comments
if one is on life support, and it will take time to recover if at all, would the fact that my organs can be donated influence the decision as to whether to save me.
in principle i agree with leaving my organs for someone, but i have a nagging suspicion, having worked with the health industry, that perhaps the grey area as to whether one should live or die, such as with euthanasia or turning off life support systems or keeping people alive due to a cocktail of drugs when the bed could be ised by someone more "worthy" and salvageable?
if by letting me pass away i can provide organs for 6 people, will the staff fight to keep me alive in a vegetable like status? assuming i may want to be kept alive of course, not that in that state i could have much sway in the matter.
that is the elephant in the room. and needs to be addressed.
there are other reasons why people choose not to donate their organs. religious reasons for some, cannot desecrate a dead body. but the WHY NOT needs to be looked at further.
France 2008 - the man was as far from being in a vegetative state as you can be.
Re 'vegetative' state - it is normally being in a 'persistent vegetative state' (ie. a reasonable period of time has elapsed and no improvement has taken place) that suggests that a person is beyond hope. There are huge 'quality of life' issues here - each person has their own view.
1) If you're in a vegetative state surgeons won't fight to save you because you're as good as dead (being brain dead is something impossible to recover from). They will turn off your life support, let you die, and give your life support system to someone who has a chance of getting better.
2) Until you have been tissue typed surgeons won't know whether who can benefit from your organs. This is only performed after death.
3) As doctors do not routinely kill organ donors it is unlikely that increasing the number of organ donors will turn doctors into genocidal monsters.
Try doing some real research on organ donation before making baseless claims.
many prefer to be buried entire- eg Jews
I'm undecided, prefer to keep me bits but....?
Now sit back and watch them reject it.
This country is becomming more and more like a dictatorship wher the people are treated like sheep.
Sounds sensible to me- I can't imagine why anybody would have a problem with it.
On an unrelated issue: even if the medical establishment was proposing presumed consent (which it isn't), I fail to see how this would be indicative of the country becoming more authoritarian. Doctors (note, doctors- not the government) are trying to find a solution which will increase the number of lives saved. Of those who disagree with a presumed consent system, most at least find the motives behind its proposal laudable.
A positive opt out may be a good idea, but if the person has no card, would a database be accurate enough. The next logical conclusion is everyone be microchipped like a dog. I can feel Gordon getting excited already, and the God Botherers concluding that the chip is the "mark of the beast" as written in Revelation.
In that case they must all be sacked by the home secretary.
Doctors are no less entitled to state opinions on law than someone from the Advisory council on the misuse of drugs stating opinions on er... the misuse of drugs
or are they?
as for agreeing to donate when you applied for a driving license, i think everyone can see why that immediately put people off
as for all the people who don't register to vote - all my male relatives for instance - they're still gonna need a fourth option!
considering the trouble i've had trying to get on/off the electoral register, my being registered twice one time, refused another, refused to vote (i had to grab the card from their hands and show them my number) - as for all those fraudulent postal votes which belonged to nobody (brum, council elections, few years back) - i don't think doctors show any sense in entrusting organ donation to the people who register voters.
the 'famous person' objection sounds insane, but if you think about how those proud republicans the French wasted hours of paramedics' time trying to revive the completely dead 'lady Di', and how supposedly patients have been thrown out of wards to make way for VIPs in various instances, it's not so mad.