Leading article: Time we opted-in to a more humane system

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The Independent Online

Organ transplant surgery is one of the great breakthroughs of modern medicine. It has already prolonged thousands of lives. And it has the potential to help countless more. But, here in the UK, it is under increasing pressure because of a lack of donors. More than 8,000 people are waiting for organ transplants in Britain. And the list is rising by 8 per cent a year. There were 2,400 organ transplants last year. But the withholding of consent from families of the deceased meant four out of 10 organs considered suitable for transplant went unused.

The problem lies in the issue of consent. Nearly three-quarters of the British public claim they would be willing to donate their organs in the event of a fatal accident or premature death. But only a quarter of us are on the register giving our explicit consent for our organs to be used in this way. Britain's register of potential donors is smaller, relative to our population, than several of our European neighbours.

To remedy this, the Government is proposing an overhaul of the UK organ donor network. One of the ideas is to double the number of dedicated "transplant co-ordinators" in the NHS. To them falls the sensitive task of identifying potential donors in intensive care and – when the time comes – persuading bereaved families. Another idea is 24-hour organ retrieval teams, to work closely with the critical care teams in hospitals. Finally, it is proposed that Britain move to a system of "presumed consent" in which everyone is a potential donor unless they choose to opt out.

All these ideas seem sensible. The presumed consent system operates in Spain, which has three times more available organs. Concerns about undue pressure being applied to families should not be dismissed out of hand, but they appear misplaced. The point of this system is to encourage a culture of donation, rather than forcing families to consent. In Spain the law presumes consent, but in practice families are always given the final say. This is where the skills of transplant co-ordinators come in. Since Spain invested heavily in their recruitment in the mid-1990s, the refusal rate has come down from 30 per cent to 15 per cent.

The benefits of transplants should not be underestimated. A single decision to donate can help three or four patients (who may need a kidney, lung, liver or cornea). The alternative for those denied a transplant is years of painful and invasive treatment or, more often, death. It is estimated that 1,000 people die every year because of the lack of donors. If the new system managed to increase the consent rate by just 10 per cent, an extra 1,200 transplants could be performed every year.

The life-prolonging element of transplants is paramount. But the money-saving potential of the technique cannot be ignored either. Dialysis for kidney failure patients costs around £25,000 per year. Meanwhile, a transplant costs £45,900 initially, followed by annual treatment costing £7,100. A greater number of transplants could save the NHS some £500m over the next decade. It would be wrong for a financially stretched NHS to fail to explore this potential saving.

The organ transplant technology revolution is not over. The success of scientists from the United States in regenerating a dead rat's heart using stem cells is a promising development. If this could be applied to humans, it would make transplanted organs far less likely to be rejected by the hosts' immune system. But that is for the future. At the moment, the primary concern for our medical system and the Government should be to persuade more of us to make the humane decision about what should happen to our organs after death.

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