Jeremy Laurance: Let's face our mortality and allow others to live

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The Independent Online

I have carried the same organ donor card for the past 25 years. It is always with me in my wallet and although I may be getting on a bit and my organs past their best, I am still a prime candidate, being a London cyclist.

Yet should someone one day scrape me off the road and find my card among my things, it would be useless. It contains the telephone number of a house I left 15 years ago and the name of my then next of kin, from whom I have been divorced for more than a decade.

Embarrassingly, I had never signed the National Organ Donor Register – until yesterday. Like millions of others, supportive in principle of donating their organs after death, I had just not got around to it.

My tardiness, and that of others, has condemned more than 1,000 people a year to their deaths, many of which might have been avoided if organ donation rates had been higher.

The situation is getting steadily worse as the numbers on the transplant waiting list climb, by 8 per cent a year. It is so critical that some transplant specialists are prepared to contemplate the extreme solution of opening up a legal market in organs to curb the growing illegal trade that is putting impoverished donors at risk.

In 2007, Sir Liam Donaldson, the Government's Chief Medical Officer for England, proposed a change from the present opt-in system, where people voluntarily decide to join the organ donor register, to an opt-out system, where people would be "presumed to consent" to organ donation unless they had registered their objection.

The idea received wide support and some version of it is in operation in at least 10 countries in Europe. But it was rejected by the Organ Donation Taskforce set up by the Government to examine it.

In its November 2008 report, the taskforce said an opt-out system was paternalistic, did not accord with the current emphasis on choice in the NHS and could damage the "vital relationship of trust" between patients and doctors. It dismissed mandated choice in a single page but ignored the idea of a three-answer version – yes, no, or "ask my relatives" – favoured by the RCP.

This version of mandated choice would resolve most of the criticims raised by the taskforce. It would also replace the presumed consent of the opt-out system with real consent, so doctors could be confident that they were acting in accordance with the patient's wishes. A survey of young adults in the US found 90 per cent said they would support mandated choice while just 60 per cent approved of presumed consent. But no similar survey has been conducted in Britain.

Reluctance to face our mortality is what deters us from making the choice about our organs. Yet it is also irresponsible not to do so, when the lives of others may depend on it. Mandated choice ensures these issues are confronted. Where the shortage of organs is so acute that bodies are being traded and donors mutilated, it is an option that demands to be properly explored.

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