NEW POLL: is presumed consent the right way to boost organ donations?

by Stephen Tall on November 17, 2008

The figures are stark. Here’s The Guardian:

An estimated 8,000 people in the UK need an organ transplant but only 3,000 operations are carried out each year. About 1,000 people in the UK die every year while waiting for a transplant.

The question is more difficult: should we move away from the current organ donor opt-in system towards a system of ‘presumed consent’, which would mean that unless people opted out of the register or family members objected, hospitals would be allowed to use their organs for transplants.

Lib Dem MP Dr Evan Harris, chair of All-Party Kidney Group and member of the British Medical Association’s Medical Ethics Committee, has previously lent his support to the idea of presumed consent:

Under an opt-out scheme donor’s real wishes will be more often respected, more lives would be saved and grieving relatives will be spared the experience of making the wrong decision at the worst time.”

Such calls have been echoed by the BMA, the Royal College of Surgeons and the Royal College of Pathologists, as well as the Prime Minister, Gordon Brown.

But today the independent Organ Donation Taskforce came out against presumed consent. You can read their full report here (PDF), but the principal concerns they noted were:

>> “the potentially negative implications for clinical practice, especially the potential to damage the vital relationship of trust between clinicians caring for people at the end of life, their patients and their families. Some intensive care staff in particular fear that a move to an opt out system would make critical care more difficult and could lead to some intensive care practitioners themselves opting out of participation in donation programmes.”

>> “powerful evidence from recipients of organs who stressed their need to know that organs had been freely given by donors and their families, and from donor families who often find great comfort in being an active part of the decision to donate.”

>> “that it would be both complex in practical terms and also costly to put in place an opt out system that could command the trust of professionals and members of the public.”

The report also notes that there was “support from members of the public and patients’ groups for the principle of informed consent, and a perception that assuming consent from silence belongs to a more paternalistic era. Some felt that an opt out system could be ‘dehumanising’. Given that current trends in healthcare place great emphasis on choice and responsiveness, this is an important consideration.”

So, here’s the question for LDV readers to consider (the poll itself is in the right-hand column): would it be right to introduce presumed consent for organ donations? Your possible answers are ‘Yes’, ‘No’ and ‘Don’t know’. Please feel free to use the comment thread for lengthier answers…

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The key point I’ve heard from the report is that they belive switching to presumed consent won’t make much difference unless the infrastructure is in place to successfully harvest and use more organs.

That means organ donation teams at more hospitals, for example.

Although I personally support presumed consent, I can see the issues and I think the report is right that, without the systems being place to exploit it, moving now could do more harm than good.

by Costigan Quist on November 17, 2008 at 2:39 pm. Reply #

I am just about in favour of presumed consent though I could possibly be persuaded the other way.

I dont see how the negative implications mentioned at the top by the report would come into play if everybody knew a regime of presumed consent existed which they should either because they were aware of the possible law change or because there should be some explanation at hospitals.

However, the points made by Costigan mitigate against an overnight law change.

by Darrell on November 17, 2008 at 3:11 pm. Reply #

Just a thought: rather than presuming either way, why don’t we ask everyone whether they wish their organs to be used in the event of their death or not?

by Joe Otten on November 17, 2008 at 3:23 pm. Reply #

A very good point Joe.

When this was brought up a while back on the I suggested to people that it should be added to the census form. People have to fill in the census form by law, so they can’t get out of at least saying yes or no.

by James Shaddock on November 17, 2008 at 3:37 pm. Reply #

No. Never. Ever.

The state should not have any claim on our bodies, or how they are used, before or after death.

By all means make it easier for people to give their assent. Have consent recorded on the driving license as in the US (or is it already?) or make asking part of the sign up for a GP.

by Tristan on November 17, 2008 at 3:49 pm. Reply #

The census point is a good illustration of what I’ve said on this issue for a while.

Every year the “governemnt” sends people a number of mailings (Council tax bills, electoral registration, car tax, TV licence). In none of those can I recall having material about Organ donation.

The opt-in system doesn’t have a good record of take up because it isn’t well promoted. When it is it tends to be in Doctor’s surgeries and Chemists which aren’t places frequented by young people who are the best prospects for donation but often don’t get round to registering.

by Hywel Morgan on November 17, 2008 at 3:50 pm. Reply #

No doubt one could make a case also that all our material posessions should go to the state for redistribution on our death by default and that that would do far more people good than just our heirs. After all, apart from the outlay on the funeral, we don’t need our material possessions either.

Personally, I think it’s only a short term answer anyway. Clearly much more money should go into research to build bespoke replacement organs. Transplants inevitably require lifetime management after the fact. It’s not ideal.

by Jock on November 17, 2008 at 3:53 pm. Reply #

Im convinced lol…by Joe and Hywel, that seems a better way around this than presumed consent.

by Darrell on November 17, 2008 at 4:13 pm. Reply #

I am all for presumed consent, but I respect the outcome of this independent review. Their insights in to, specifically, how many organs are wasted because of poor infrastructure were especially interesting.

Clearly there are other things to get sorted before we start moving down the much more liberal route of presumed consent.

by Lee Griffin on November 17, 2008 at 4:21 pm. Reply #

“No doubt one could make a case also that all our material posessions should go to the state for redistribution on our death by default and that that would do far more people good than just our heirs. After all, apart from the outlay on the funeral, we don’t need our material possessions either.”

Let’s not sully this debate with ridiculously over-simplified analogies. Unless what you’re really saying is that dying heirs should always get first dibs on organs?

by Lee Griffin on November 17, 2008 at 4:23 pm. Reply #

I’m worried that those who are less articulate – illiterate people, for example – may have trouble opting out. For that reason, I don’t think I can support it.

by Thomas Hemsley on November 17, 2008 at 5:26 pm. Reply #

Joe’s suggestion is an excellent one — I have signed up today, having never got around to it before, to my shame.

Including it in tax returns or censuses is what should be done.

Presumed consent is a fundamental shift in the relationship between the individual in the state, and one we should not make lightly.

by Richard Huzzey on November 17, 2008 at 6:26 pm. Reply #

The reason I suggested the census was that it is something that covers the entire population and is in effect mandatory, whereas the likes of tax returns, passport forms or driving licences are subjective depending on whether you require or wish to have one.

I feel the census is an untapped resource in terms of things like this, as it could clearly be successful as a means of distributing information as it already is in collecting it.

by James Shaddock on November 17, 2008 at 6:32 pm. Reply #

I’m in favour of assumed consent, but I’d always felt this was at odds with the myriad things that made me feel a liberal. I don’t want to cede control over my body to the Government, even after my death. The stark numbers quoted above make me feel I should make an exception on this crucial issue – but it is an exception.

by Russ on November 17, 2008 at 9:24 pm. Reply #

Why not let people opt out of donating their organs at death, but with the price tag that they simultaneously surrender irreversibly and for life the chance to receive donated organs should they need one?

by Anon on November 17, 2008 at 9:25 pm. Reply #

“cede control over my body to the Government”

This, to me, is a very strange way of looking at it. Rather it’s a more simple case of possibly being able to give one of my fellow humans the gift of life with my, now unneeded, body.

by Steven Ronald on November 18, 2008 at 1:05 pm. Reply #

Voting is almost even.

Guess which way I swung 😉

by asquith on November 18, 2008 at 6:04 pm. Reply #

I’d prefer a half way implied consent, if someone carries a donor card there should be no need to ask the next of kin the donor has already consented.

by peter on November 19, 2008 at 3:51 pm. Reply #

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