How do you save hundreds of lives a year in England? Answer: by shifting the present system of consent for organ and tissue donation from opt-in, to opt-out.
The UK government has just confirmed that it will introduce new legislation in 2020 to change the present system of asking people to opt into the system for donation. From then on, it will be assumed that people have given consent for their organs to be used after their death – unless they have expressly asked for this not to happen. The government calculates that this shift could save up to 700 lives a year.
The shortage of organs for transplant is a global problem, and some countries have done better than others at tackling it. Spain is the most successful country in the world by a clear margin. It operates an opt-out system and this is one of the reasons why the supply of organs have saved proportionately more lives than in other countries.
Scotland, which is also considering moving to opt-out, has pushed hard at increasing the proportion of people who opt-in. Last week it announced that the organ donation register now covers more than half the population.
There are obvious concerns. One is that the essential safeguards are effective, in the case of England the government has announced that children under 18 will be excluded, as will people who are mentally incapacitated and unable to make the decision for themselves.
People who have lived in the country for less than 12 months will also be excluded. A second concern is the practical effectiveness of the switch. In Wales, where opt-out has been the norm since 2015, the supply of donors has increased only marginally.
This is counter-intuitive and more work is needed to understand why this should be so. The experience of Spain suggests that there are other issues. For example, in the administration of the matching system. That needs to be examined if the full benefits of a greater supply of organs flow through into better health outcomes.
That leads to a wider point. Countries can learn from each other how to make changes in legislation, small in themselves, that cumulatively can massively increase the well-being of their citizens. There are many examples: from the gradual discouragement of smoking over many years, through to the present campaign against single-use plastic bags. Ireland pioneered a levy on plastic bags right back in 2002, a move that has been imitated around the world. It is now considering a similar charge on disposable coffee cups and lids, which if enacted would be the first in the world.
There are costs to all such change. For example, legislation against smoking in public places has indeed brought great health benefits (including to bar staff as well as to clients), but it has also put pressure on pubs. So changes to legislation have to flow with the tide of public opinion: there has to be a general sense that the changes make sense, even if some individuals and some businesses suffer as a result.
But the principle that people should have to opt-out of a measure that brings social advantages to the community is surely a sound one. No one is being forced to do anything. No one suffers. If people do not wish to follow general practice – in this case leaving their organs for the use of others after their death – then that is absolutely their right to do so. There should be no social pressure on people to conform. With that proviso the government’s proposal deserves a warm welcome.
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