Death is rarely a comfortable subject for discussion. Sudden death of relatively young people is even less a normal item of conversation. The debate over organ donations demands that it be addressed squarely. The report of the organ donation task force does not confront the controversy over whether Britain should move to a system of “presumed consent” because that was not its remit in this instance. It instead sets out ways in which the NHS could make the case for donating more effectively to grieving relatives and improve the quality of organ collection. That there is a head of steam behind presumed consent is, however, undeniable. The Chief Medical Officer has endorsed it. The Prime Minister has signalled his personal support for it. Alan Johnson, the Health Secretary, said that this task force's work was a “first step”.

In an inevitably emotive area, facts enter the battlefield wearing little armour. A few statistics and practicalities must still be considered. At any time, around 8,000 people in the United Kingdom are in urgent need of an organ transplant and thousands more could benefit from one. Opinion polls indicate that 90 per cent of the public back donations in general yet four in ten requests for them at hospitals are denied by the loved ones of the deceased. This does not often happen if individuals have put their name on the NHS organ donor register, but three quarters of the population have not done so. The contention is that relatives, who even under a presumed- consent regime would retain a right of veto, would be far more willing to allow an organ to be withdrawn if this were the “norm” rather than them having actively to make that choice.

Such a change would, though, be an immensely dubious violation of the sanctity of the body. There would be a subtle alteration in the balance between the ambitions of the State and the instincts of families who may have no idea what the preference of those they have lost would be.

Presumed consent has, in addition, arrived on the agenda because of failures in public health elsewhere. The rate of refusals was only 30 per cent, not 40 per cent, less than a decade ago. It has increased by a third since then in large part because of scandals such as that at Alder Hay hospital, where body parts of the dead were taken without proper permission for scientific research.

The presumed consent lobby is mistaken in principle. It suggests that the State has rights which it does not. This is not a matter of state entitlement but of state efficiency. It is not doing a good enough job at encouraging donations.

If we want to increase the numbers of organs available but still respect the rights of the individual, as we should wish to do, the answer is not for the State to assume ownership of people's bodies as soon as they are dead. Instead, it is to ask them while they are still alive. Participation in society should require answering the question.

When people get a driving licence, when they fill out their tax forms or when they participate in a census, and at other times when they face official forms of this kind, they should be asked whether they are willing to hand over their organs after their death or whether they would prefer not to. Answering this should be an obligation.

The result of such an initiative would surely be a really substantial increase in organ transplants. Yet this would have occurred through the knowing choice of the living before death, instead of manipulating the rules of consent to press those racked with anguish not to object to donations.