IF anyone ever had doubts about the importance of government efforts to increase the number of organ donors, they need only read Rachel Johnson’s buoyant account of her husband’s successful liver transplant (A transplant war of my own, News Review, and Letters, last week). Organ transplantation saves and transforms young lives, but of the 8,000 patients now waiting, many will die unnecessarily before a donor organ becomes available.

Donation rates in the UK are lamentable by comparison with many other European countries and North America because we do not have a system that enables organs to be donated from many potential givers who would have wished this to happen.

The current system is failing both organ donors and transplant patients. Whether or not his is a view shared by everyone, the prime minister, Gordon Brown, has chosen to put his head above the parapet and propose a solution. This is not the action of a politician wishing to gain popularity; it is the action of a man following his conscience, and he should be applauded for it. Peter Friend President, British Society of Transplantation

Trust me, I’m a doctor

I can understand why anyone waiting for a transplant would be desperate to stop organs being “wasted”. But taking organs without the consent of the families of the potential donors could result in a disastrous loss of trust between health professionals and their patients (I speak as a retired consultant surgeon who has had the harrowing experience of asking relatives to donate).

Imagine the following scenario. You are the devastated wife of a man who has just been involved in a bad accident. The surgeon tells you that your husband is brain-dead and the transplant teams will be taking his organs. Only he does not look dead. He may be unconscious and on a ventilator, but he is warm and pink and his heart is beating. One, very human, response is to cling on in the hope the surgeon is wrong. By the time it is obvious to a non-professional that death is imminent, the organs are probably not worth having.

It is not difficult to see how, in this situation, the family could convince themselves that organs have been removed from a patient who might have survived. Then there are the headlines: “Hospital removes organs from live patient” with a small note, “woman alleges”. Once a scare has been started, it may take decades to repair the damage. Ursula Mulcahy Springwell, Gateshead

A presumption too far

The current system is self-defeating and laborious and should be changed, but presumed consent is perhaps a step too far. I believe, however, that the wishes of those who register to be a donor should be respected and that relatives should not be able to override that decision.

There is still much work to be done around the ethics of transplantation and, indeed, NHS treatment per se – my view is that those who abuse and neglect their bodies should not expect the taxpayer to fund their treatment, and the NHS should refuse to provide it – including organ transplants. Name and address supplied

Consent is key

Johnson’s attitude is understandable but misguided. Many organ recipients realise the magnitude of the sacrifice and generosity involved.

Converting volunteers into conscripts or conscientious objectors is wrong on principle. It would break the golden thread that runs through all healthcare: informed consent. The first case of “pretend” consent assumed in error would savage support for donation, with tragic consequences for everyone. Roger Goss Co-director, Patient Concern London SW5

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