Leading article: The case for presuming consent

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More than 17 million people have now registered to donate their organs after their death. This welcome rise comes thanks to public education programmes and the appointment by many hospitals of specialist transplant nurses to liaise with families when death seems imminent. Unfortunately it does not meet the constantly increasing need. Transplants rose by 5 per cent last year to a record 3,706 organs. Yet there are still nearly 8,000 people on the waiting lists. The number of people needing new livers alone increased 11 per cent last year. Three people die every day, on average, for want of a transplant.

There are tricky ethical issues about increases to incentives. To pay for organs, like kidneys, might tempt the poor to risk their lives. The idea that a donor should be given priority if they require a transplant later in life raises problems of need versus desert. The British Medical Association and the British Heart Foundation both want to switch to a system of presumed consent, where it is assumed everyone is willing to donate unless they opt out. In the past that idea has met with hostility, partly out of squeamishness, partly because many feel the state is untrustworthy to administer these matters. But countries that use this system have 25-30 per cent more organs available for transplant. Surveys show that 90 per cent of Britons support organ donation and yet the law currently assumes the opposite. Since only 23 per cent of the population have registered their wish to donate, thousands of bodies are buried or cremated with viable organs simply because people never got around to making their wishes known. The decision falls to the family when they have just been told their relative has died or is dying.

A system of presumed consent would allow distressed families to override default permission. But it would routinely relieve them of the burden of decision-making at a time when they are perhaps least able to make a balanced judgement. It would be good for those who need a transplant, good for those who support donation and good too for those who oppose donation because their wishes could be formally recorded and made mandatory. It is time the idea was floated with the public again.

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