Editorial: A donor card should be binding

Despite an increase in donations of organs for transplant, the supply still falls far short of what is needed. Should we then ignore the qualms of grieving relatives?

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While the number of people donating their  organs for transplants has increased by the 50 per cent hoped for over the past four years, the supply still falls far short of what is needed. Now, the experts who make up the UK Organ Donation Taskforce are proposing that an individual’s intention should be respected in all circumstances. Last year, it says, the organs of more than 100 people who carried donor cards could not be used because relatives refused.  Those organs could have saved many lives.

It is understandable that relatives may have principled objections, or just personal qualms, about giving the go-ahead for the organs of a family member to be donated. Understandable, too, that doctors and other medical staff may feel uncomfortable about asking those who have just lost someone close to them about organ donation. That speed is of the essence does not make posing the question any easier.

But the law says the donor’s wish is paramount. Just as relatives do not have an automatic right to overturn a will, they cannot overrule a decision about organ donation either. The ODTF, rightly, wants practice to come into line with the law. Such clarity would help obviate awkward conversations.

Another of the ODTF’s proposals, however, needs more careful consideration. It suggests that merit awards for doctors and departments might be made conditional on their referring  potential donors to the transplant service, or – put another way – that they should be penalised for habitually not doing so. For the NHS to link certain practices, however beneficial, with financial rewards risks perverse consequences.

Giving GPs incentives to take a patient’s blood pressure is one thing; incentivising surgeons, say, to increase the number of organ donors is quite another. Serious questions were raised by the rewards given to hospitals for placing patients who were not expected to recover on the so-called Liverpool Care Pathway. Soliciting organ donations is no less sensitive an issue. Financial linkage must be avoided at all costs.

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