British citizens should be presumed willing to have their organs removed after they die and transplanted into those who need them, the Chief Medical Officer said yesterday.

In his annual report, Sir Liam Donaldson recommended moving to a system of presumed consent, in an attempt to increase the number of organs for donation. Britain lags behind many other countries — some of which already have such systems — in ensuring the availability of organs.

Every day, Sir Liam said, somebody in Britain died whose life could have been extended by a transplant. The number of organs needed consistently exceeded supply, and although the majority of people favoured giving organs, the reality was that only a small minority ever did.

Many organisations, including the British Medical Association, have called for a switch from “opt-in” to “opt-out”. What this would mean is that unless individuals opted out, their organs could be used. At present, people have to opt in by joining the Organ Donor Register.

“Opt-in simply hasn’t given us the numbers,” Sir Liam said. “We should move to opt-out, where everyone is on the donor register unless they choose to remove their names.”

His proposal received a mixed reception: welcomed by the BMA but greeted coolly by the Patients’ Association.

Figures from UK Transplant showed that 7,234 patients were registered as waiting for a transplant on March 31 — 8 per cent higher than a year ago. They also showed that 3,074 patients received a transplant in the year to the end of March — 10 per cent more than in the previous year and the highest number on record.

But the numbers on the waiting list are still rising, and the proportion who get a transplant is falling.

Britain has one of the lowest organ donation rates in developed countries, said Sir Liam, who pointed to the “highly successful” case of Spain, which was in a similar situation but managed to more than double its rates of donation since bringing in an opt-out system.

If such a system were to be introduced here, there would be safeguards to ensure that religious and faith groups that did not wish to donate organs could opt out easily. The views of relatives who felt strongly about donating organs would also be respected in “special circumstances”.

Three years ago MPs voted against such proposals. But Sir Liam said the “widening gulf” between the number of people on the transplant waiting list and registered donors would change their minds. He said: “This is a recommendation and it is now for the public and the Government to look at it and see whether they want to do it, and part of that would be looking at the logistics and precise design of the system.”

Tony Calland, chairman of the British Medical Association’s medical ethics committee, said: “The BMA fully supports an opt-out system for organ donation.

“We must increase the number of donors available and the BMA believes that a system of presumed consent with safeguards will help to achieve this.”

But Timothy Statham, chief executive of the National Kidney Federation, said such a change would not produce a dramatic rise in organ transplants because the NHS did not have the infrastructure to deal with them.

“To make a difference we need more surgeons, we need more intensive care unit beds, we need the Government to put more money behind transplantation and we need more willing donors,” he said.

The Patients’ Association was also sceptical. Katherine Murphy, its director of communications, said: “It is dangerous to presume patients’ wishes at a time when difficult decisions need to be made immediately. It is not always possible to contact a next of kin in time, so we must not take for granted that presumed consent for all is the answer.”

Professor Adrian Newland, president of the Royal College of Pathologists, said there was “no reason to believe” that the presumed consent would not work as well in Britain as it had elsewhere.

He said: “As the overwhelming majority of the population would wish to offer their organs for transplant, we need to translate that overwhelming act of charity into reality, and the time has now come to convert presumed consent into positive action.”

Keith Rigg, vice-president of the British Transplantation Society and a consultant surgeon at Nottingham University Hospitals NHS Trust, emphasised the need for clarity in any new rules. “An opt-out system may be one way to help meet the demand, but if introduced must ensure that those opting in or out did so with informed consent.”

Children and babies presented special problems of consent, said Anne Keatley-Clarke, chief executive of the Children’s Heart Federation. “It will probably always be necessary to obtain the consent of the families of young donors,” she said.

‘Promote the register more before choosing opt-outs’

Jo Keeling, a 27-year-old artist, suffered a brain haemorrhage while on a night out with friends two years ago.

Within hours of her death her parents had to decide whether they should allow her organs to be used in tranpslants.

“I said that I thought we should allow her organs to be donated”, recalls her mother, Maggie.

“I suggested it to her brother and sister and they both agreed. The hospital got in touch with an organ donor co-ordinator. By the time the co-ordinator had come down from London, the hospital had checked on the organ donor register and Jo’s name was on there, so we had confirmation that we had made the right decision.”

Jo donated her kidneys, liver, corneas, skin tissue and heart valves.

Two months later the family received a thank-you letter from a young girl who had been the recipient of one of Jo’s kidneys.

“It was fantastic,” Mrs Keeling said. “It brings the whole thing back to you but it also makes you realise that some good comes out of it and it stopped another family from going through the pain we went through.”

Yet Mrs Keeling does not think that presumed consent is the best option.

“It’s still a very difficult thing for a family. For some people it’s such a difficult time. I feel there should be more exposure of the register and that we should try to really encourage everybody to sign up.

“We should go into schools and offices — it only takes 30 seconds to register. We should try harder to get people to register before going down the opt-out route.”

'After my brother died, he helped 17 other people to live'

When Christine Cox’s brother, Peter, died of an inoperable brain tumour in 1989 aged 24, her family decided that something positive would come from the tragedy.

They began campaigning for a national register of donors, to correspond to the register of patients awaiting transplants.

“Peter’s dying wish was that he wanted to be an organ donor,” she said.

And, according to Ms Cox, it is a dying wish from which at least 17 people have benefited. “Those 17 people include a man who received his heart and lived for another 12 years and lived to see his grandchildren born, and a teacher who was able to come off dialysis and take up full-time teaching again.”

The National Donor Register was introduced in 1994. Ms Cox said: “At the time we were told that the British public were not quite ready for presumed consent.

“But people are now proud that when, tragically, they lose a child they speak in newspapers about the benefit of organ donation. In 1990 it was a taboo.”

She believes that the introduction of an opt-out system of organ donation would signal the completion of the work begun by her and her father 17 years ago.

“At the moment we are under the opt-in system, but we’re not making progress. There are still 17,500 people on transplant waiting lists and 22,000 on dialysis.

“The only thing that’s stopping us from making progress is the shortage of organs.”

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