Leading article: New thinking on a matter of life and death

The Nuffield Council on Bioethics has launched a consultation. Its subject will be matters of life, death and morality. For the next three months the council will be taking soundings from the public on whether it would be ethical for the state to use financial incentives to deal with the shortfall in public donations of sperm, eggs and organs. Notwithstanding the anguish of the infertile, most would accept that it is the lack of organs for transplant which is the most pressing.

The problem is plain enough. Some 8,000 people in the UK are on the waiting list for a new organ. Yet the supply is falling considerably short of this demand. The grim consequence is that around 1,000 people die each year waiting for a transplant, many in severe pain and discomfort.

Nuffield has floated various ideas to induce people to join the organ donor register, ranging from the trivial (souvenir T-shirts and mugs) to the more serious (a promise to pay funeral costs and priority for the donor should they require a transplant themselves later in life). The council will also look at how organ donation systems work in other countries.

Announcing the consultation yesterday, one of Nuffield's representatives, Dame Marilyn Strathern, stressed the need to address head on the moral issues involved in creating incentives to donate organs. On that subject, Joyce Robins of the charity Patient Concern has already made up her mind, arguing yesterday that "paying living donors for organs is abhorrent as this would be tempting the poor to risk their lives". We must hope that this exercise will take us beyond such knee-jerk responses. For one thing, in the light of the growing trend of well-off people to pay to go abroad for transplants, it is arguably the poor who would stand to benefit most from an increase in the supply of organs.

If the council is going to investigate the manner in which other countries do things, it will have to analyse the system of "presumed consent", whereby the public is required to "opt-out" rather than "opt-in" to the donor register. Whenever this idea is raised in Britain, it tends to provoke public hostility, as was the case when the Royal College of Physicians recommended it last year.

And in some ways this antipathy is understandable. There is of course the "yuk" factor, which turns many people off. But there is also the more serious issue of the trustworthiness of the state. Memories of the Alder Hey scandal, where organs were removed from deceased children without the permission of their parents, are still vivid. And there is no public urge to give the state more powers given its sorry record on civil liberties in recent years.

Furthermore, the evidence on whether such a system would actually increase the supply of organs for transplant is, in any case, ambiguous. While Spain, which has a system of presumed consent, has more donors proportionately than Britain, the Government's Organ Donation Taskforce came to the conclusion last year that implementing such a system here would not dramatically increase supply. The Taskforce recommended, instead, that public resources be channelled in to improving the infrastructure surrounding organ donation and the launch of a new awareness campaign.

Yet it is difficult to see such measures alone being sufficient to make the necessary breakthrough. An ageing population and improvements in medicine that enable more people to benefit from transplants is steadily pushing up demand for organs every year. New thinking is urgently required on how to increase supply. It is to be hoped that this new consultation will be fearless in its efforts to produce it.