Letter: Organ donation: a national databank could lead to uninformed consent

Sir: The national computer register for organ donation from almost the whole of the adult population that you headline today (17 August) will introduce 'opting- out' by the back door. After these years of propaganda that organ donation is a Good Thing and a public duty, those confronted by requests on driving licences, by their GPs or by the 10 million forms to be issued through public offices will have little choice but to acquiesce.

Very few indeed will have access to the facts needed in order to give informed consent. Consent to any other, even trivial, surgical procedure requires that a full explanation of the effects and alternatives is given by a doctor who countersigns the consent form, and that the nature of any anaesthesia is discussed. For this most final of operations such protection is dispensed with.

The undoubted physical benefits for many recipients of organs are obtained at the cost of concealing much of the truth. Your terminology, for instance, encourages this. Of the two tragic stories you say that one young man 'died in a car accident' and the other 'died run over by a car'.

Both, in fact, must have died later in hospital, not at the time of the accident. You quote parents saying 'We gave permission and that really was it.'

Many people believe that the life support is discontinued before any organs are removed, but protocols for dealing with donors include continuing, and increasing, support procedures that are no longer directed towards the survival of the patient but towards the preservation of organs.

The declaration of death has been made a matter of opinion rather than of fact. Under normal circumstances, one doctor certifies death on the basis that there is no heartbeat and no breathing. Organ donation (apart from eyes) requires that mechanical ventilation and natural heartbeat continue, and it requires four doctors' opinions (or two doctors twice) to declare that patient dead.

Because it is a matter of opinion, there are many doctors who would never certify death under those circumstances and their opinion, clearly, is not asked. Many, but not all, protocols include that anaesthesia as well as muscle paralysis should be given for the operation to remove organs. This is to control body movement and blood pressure and pulse rate, but also because it is recognised that not all brain activity need have ceased.

Even with this knowledge, some will still agree to organ donation. They might like to be reassured that full anaesthesia will be given. If others decline, this must be regarded as part of the price of truth, and they must not be made to believe that such refusal is in some way anti-social, either by the Government or those whose hopes of restoration to health have been raised by the possibility of organ transplantation.

Yours faithfully,

DAVID J. HILL

Huntingdon,

Cambridgeshire

17 August

The writer is a consultant

anaesthetist.