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.”
Death is sad and organ transplants do a lot of good work in preventing or delaying that inevitability. However, I do feel a lot of NHS money goes into the more glamourous side of health care (i.e. breakthrough surgery procedures) and not enough is spent on the more mundane side of things. Ooh, like getting enough doctors and nurses into our hospitals in the first place.
Lee Allum, Manchester, UK
Dear Sirs,
I am the Timothey Staham of the National Kidney Federation quoted in this article and I want to make it absolutely clear that I and the National Kidney Federation do favour a change to an Opt Out system. Your article implies that we do not ,and this is incorrect. I did make the points shown, but they were in addition to supporting the proposal - and not as an alternative. This error has concerned Kidney Patients as they rightly expect the NKF to support presumed Consent.
Timothy F Styatham OBE, Hinckley, UK
Dispite the ethical questions such a system would raise, I wonder if the CMO has considered the practical & legal ramifications of an opt-out scheme.
Without a decent IT system to manage the potential organ donor patient history, who's to say such a scheme wouldn't introduce more harm, both phsyically & financially, than good.
I fear if this is a demostration of the level of thought that goes into other NHS proposals, no wonder we are where we are at today.
I'd advise thinking a little harder before openign your mouth.
Chodberry, London, UK
I get what your saying E James, but I don't think that's really going to happen. Doctors and nurses don't want any of their patients to die if they can help it, because it reflects badly on them. And if it's a choice of letting either the guy in the accident or the guy who needs an organ transplant, they'll treat the guy in the accident because in most cases he's going to have a better chance of survival. At the very least, the NHS doesn't have to fork out for the anti-rejection drugs that the other guy would need.
Alice, Sheffield,
I am on the organ donor register, and do not have religious faith, but would withdraw from an opt-out system on principle. We should try to make an opt-in system work rather than introduce compulsion. Let’s promote the register and give present donors over 18 the power to overrule at the point of opting in any potential objection from next of kin. It is ridiculous that we have a register yet still rely on asking a distressed family for consent.
The suggestion that only people on the register should be eligible for transplants is the most appalling bullying. I do not expect that a person who might receive my organs after my death should have to qualify by being "worthy" in any way, either through being on the register themselves, or sharing my sex, skin colour, or political views. Our bodies should be a gift we choose to give freely, not objects for trade.
Catherine, Oxford,
All well and good.
I used to be regular blood donor. As well as my normal blood contribution, they used to a little extra for antibodies I had.
I had been doing this for years. Now because I had an operation in 1982, I am no longer allowed, so I doubt they would want my organs, as they must be contaminated as well.
I have been carrying an organ donor card since they came out, but I suppose I should bin that, other than the fact this has my next of kin on it. So it is useful for something after all.
Paul Steel, Hitchin, Herts
It sounds like a good idea in theory, but there could be problems in the implementation. Could the NHS fund many more transplants? Plus all the necessary tests on the "donor bodies" during which presumably they would have to be kept alive on life support to keep the organs viable while they were matched up with compatible recipients.
Once they have harvested any organs, would they then be prepared to pay for disposal of the body, if no next of kin came forward?
Anne Izzard, Leicester, England
I understand the desperation felt by those who need organs and their medical attendants, but for the rest of us one important question hovers over the idea of registering to opt out.
Privacy.
Why should we have to enter our names on yet another register in these days of worries over ID cards and what people will do with our data?
If I choose to opt in that is fine, but I should not have to register to rebut an assumption foisted on me by government.
Fenris Wolf, Birmingham, UK
If the NHS hasn’t got enough to cope with, another mp who doesn’t know what he is talking about.
Spending masses amount of money on changing the system, let people decide what they want and give their own consent when appropriate,
it does not need changing.
It’s just more cost for the health service.
I do hope labour goes out in the next election, so we can gain our NHS back. from the rot.
More paper work and this is what labour are all about and I can tell you the hospital I work at are up in arms over these comments.
I will write again when the hospital shuts down next month. These silly men who know nothing about reality.
hall, midlands, staffordshire
Hi Maz,
I am sorry to say that if you smoke or drink, you probably won’t survive the operation or after care, either you die, or the organs are wasted by rejection, so no, transplant units do not waste such precious organs on people who are as irresponsible as that.
People are told to stop, if they don’t they are told they wont get a transplant, if they still wont listen then that is their outlook. Why waste resources on a fool, after all there are more people needing a transplant than organs to go round.
Alex, Tunbridge Wells, UK
"Over himself, over his own BODY and mind, the individual is sovereign" - J.S. Mill
Alex asks if those opting out should be allowed to benefit from a transplant in turn. I have no problems with opting out both as donor and potential recipient--it's lefties who are hypocrites, not those of us on the Right.
To those who support "presumed consent" (yet another erosion of liberty), you might consider the "law of unintended consequences". Whilst I don't carry an organ donor card, I have no issues with my next of kin granting permission for my organs to be "harvested" after death--but if this illiberal measure of presumed consent becomes law or practice, I will most definitely opt out, and in the clearest legally-binding manner possible. How many other liberty-minded individuals feel similarly? Two kinds of people in the world: push some, and they bend their head and apologise; push others, and they push right back.
DGH, Kirkcaldy, North Britain
Forgive me for being selfish, but its my body and not the country's. I am a student nurse and I understand that donations are important for the health of our nation.
However. My body buried in the ground. Thats where its staying. Sorry Mr Medical Officer. I'm opting out, thanks. How dare he think people are all going to be OK with this. Its a human right after all.
Lucy Auton, Exeter, Somerset
considering all the mistakes made by banks, utilities, hospitals re records, etc these days, I would not trust the opt out system. I can imagine doctors taking organs and then discovering someone had opted out after all but papers/computer records lost or mixed up!! And what about mentally ill/elderly etc that can't speak for themselves - this is open to abuse and could encourage more medical neg. claims from relatives. My husband was a med neg lawyer some years ago and was always having calls from doctors to enquire whether they could 'switch off' life support machines to enable them to collect organs - his advice was always 'no'.
Glenis Malone, ST Leonards, United Kingdom
I agree with Alex in principle but a doctor will have difficulty dealing with that statement. If you are unlucky enough to die in an accident what greater gift can you give anybody but an organ transplant
robbie mac, marford, Wales
I`ve been on the donor register since I was old enough to vote and I think it is better for everyone to be a potential donor. If a member of my family were to suddenly die then I know it would help with the grieving process that their untimely death had helped 17 other people to live. Death in old age is expected but one should never outlive one`s children. I bet there are thousands of people who would gladly register if only they knew how to go about it - after all, not everyone takes out a provisional driving licence!
Beth, Liverpool, UK
I think this is the best idea anyone in this country has had for a long time. What is the point in just burying or cremating organs that could have saved someone else's life? What use are they to you when you are dead? How selfish do you have to be to hold them back from someone who is dying?
Obviously some people will want to opt out for religious reasons and they have the choice to do so, but I believe everyone should donate their organs if they can.
And it doesn't make you property of the state, as you have the choice not to donate, it just allows more people to save lives!
Melissa, Watford,
I am whole-heartedly behind an opt-out scheme. Obviously it needs to be designed and thought about very carefully but if it works so well in other countries such as Spain, why shouldn't it work just as effectively here? I think it's such a massive waste and really do not understand those that are anti this stance. It's a little like being a blood donor. As Alex says, who knows when any of us might need an organ or blood transplant. If we expect to receive, then surely we can only be prepared to give?
Becky Foulds, Cheltenham, UK
i would say yes if everyone was treated eqally but we are not drugs and treatments are either by whether you are scot[v.g] wesh and irish not so good english very bad and also religious grounds can be used to escape then organs should not be given to these people but really it will not happen you will have enough organs enough people wanting them but not enough money or surgeons for the procedures and drugsthat are required just another bit of NEW LABOUR fiddle faddle
jonahdad, stafford,
I was never sure how to register, when I lived in the UK, despite being a nurse. None of my colleagues seemed to be sure, either. I merely carried a donor card and informed my wife and family of my wishes.
I do think that, given the haphazard way in which the system was run, an opt-out system would be preferable. It would surely be better for a few relatives to be upset and give many more people a longer, more bearable life, than to pander to the fallacious defence of 'human rights' (selfishness?). It would not equate to compulsory donation of organs, in any case. If anything, it might shift the burden of choice, or guilt, away from the relatives, the choice having already been made, albeit in a passive way.
Having said that, I disagree with withholding transplants for non-donors. Apart from the moral and practical problems, it would create huge ethical dilemmas for medical staff. Unless you've been in that kind of situation (I have), you really can't appreciate it.
Nick McGine, Wuhan, China
Its my body. Even when i'm dead. You can't touch it unless I say so.
John Oliver, Croydon,
I think that once everyone has adjusted to the opt out system, we would see that it is a much better system. I received a kidney from my brother nearly ten years ago and it made a dramatic improvement to my quality of life; when I die, any part of my body may be used if it can benefit someone else. For the bereaved family, the opt out system would offer the knowledge that some good will come out of their tragedy without them having to agonise over the decision.
Jackie Shanahan, North Walsham, UK
Seems like theft, to me.
R Pryor, Vancouver, Canada
My father went into undiagnosed renal failure in his early 50's. We campaigned hard for a transplant ("too old at 55") and following several harrowing years on dialysis at 59 years he eventual got the call and he was given back his life which continued apace for over 15 years, his eventual death being unrelated to his kidney.
At 16 my son won a treasured army sponsorship for sixth form, university and officer training something he had longed for since joining CCF at school. At his medical the army discovered he had inherited congenital degenerative kidney disease and had to withdraw his place. He was devastated, not because of his illness but because he couldn't pursue his chosen career.
Last week, at 27 years, his consultant told him his kidney function had deteriorated to 22% - his next appointment would be to discuss dialysis and transplant options.
All at once he is stoic, pragmatic, brave and scared. He needs a kidney. He is bottom of the list. He needs donor opt out.
Penny Cummings, Dorking, UK
The system should remain as it is.
If the majority of people want to donate, then they would carry a donor card. It is a nonsense to say that people "dont' get round to it".
Also, Alex makes an interesting point. If we ban those who refuse consent to ever receive an organ, could we also please ban smokers and alcoholics and junkies from EVER receiving a donated organ? Why should those who willingly abuse their bodies ever be given a second chance?
Maz, Yorkshire, England
Don't forget: this is the NHS-- the people who go to court to defend their right to deny treatment:
http://www.timesonline.co.uk/tol/news/uk/health/article465526.ece
http://news.bbc.co.uk/1/hi/england/lancashire/4955960.stm
"A joint investigation by the Healthcare Commission, the Audit Commission and the Commission for Social Care Inspector found that widespread ageism means that the elderly are regarded as a low priority by NHS staff and denied a voice in the planning of healthcare."
http://www.timesonline.co.uk/tol/news/uk/health/article1082553.ece
NHS accidents 'kill 30,000 a year'
http://www.timesonline.co.uk/tol/news/uk/article585821.ece
Doctors: let us kill disabled babies
http://www.timesonline.co.uk/tol/news/uk/article625477.ece
Whatever happened to the Hippocratic Oath?
DGH, Kirkcaldy, North Britain
I would opt out. In the current climate where doctors can refuse to treat patients who smoke, or are obese, I would be concerned that someone wouldn't like my face, or would not treat me because I was obese, and regard me as "spare parts". Unlikely? My husband died 22/12/05. The Consultant said he didn't have to treat my husband because he still smoked. I asked why he should be penalised for smoking when George Best got a liver transplant though still drinking? His answer? "Because Tony Blair says I can choose not to treat him".
Imagine how distressing it would be if a relative of yours were to be carved up against your wishes [or religeous beliefs] because your relative had meant to opt out, but thought there was no need to rush or just forgot. Promote Organ Donation. Don't force it on people who don't want it.
Beryl, WINDSOR, England
I am not the property of the state nor will I ever be
john, nottingham,
And since charities are struggling to raise enough money, all your money should go to charity when you die unless you opt out? Possibly, but I would tend to opt out. And who protects the interests of those not able to answer for themselves?
I also believe that anyone opting out of donating organs should automatically forfeit their right to receive organs.
Mike Poulsen, Reading, Berkshire
when I die whoever needs them is welcome to my organs. However I want to be assured that the doctor involved will make sure I am dead if I was say in an accident. Surely it would be better if the Government spent more money on research to avoid the diseases which neccesitate transplants.
Gina Myrie, Edgware,
If you opt out, you should not be able to receive any organ from anybody else. If you opt in, but your family later refuse, then they should be put on the stop list.
I am diabetic and have had major heart surgery. I am told that only my corneas could be used, but anybody who has opted in is welcome to them and anything else that is usable when I am dead.
Raymond, Haslemere, England
I am an Kidney and a Pancreas recipient, To anyone who carries a card or supports opt out, thank you, its the right thing to do and a very unselfish thing, I would have been dead long ago without some young man in his 20's carrying a donor card and his family having the decency to say yes when asked.. But the real question for everyone is:- SHOULD THOSE THAT OPT OUT BE ALLOWED TO BENIFIT FROM A TRANSPLANT IF THEY EVER NEEDED ONE? Please remember, you can need an organ at any time in your life, purely by being in an accident. My personal thought is NO, but what would your thoughts on the issue be?
Alex, Tunbridge Wells, UK
If the Opt Out system is allowed, it will improve donor numbers by simply taking freedom of choice away. People will have the responsibility and emotional aspect of having to explicitly protest against this. To assume that the misfortune of individuals should dictate what every person should be made to do is just not part of being in a free, democratic society. Thousands of patients have died from MRSA yet how many Medical Officers, Doctors and medics have been made responsible? In most cases it just gets overlooked and forgotten. With this knowledge, how do we know our lives will be properly treated if we are in an accident? There will be no way of knowing that we won't be coveniently left to die in order for our organs to be used for transplantation? No one has mentioned the financial boost that the Medical World/Insurance companies will receive if nearly 60 million people are automatically made to donate their organs!? Hundreds of these cases could occur uninvestigated!!..
E James, London, UK