Dr Thomas Stuttaford's next online forum (live on January 23, 1pm) is : should people have to opt out of organ donation? To ask the doctor your question on this topic and to read other recent topics he has answered click here

Since time immemorial people have been preoccupied with death and, in many cultures and religions, resurrection. Traditional funereal rites and customs are embedded firmly in nearly everyone’s psyche.

The Prime Minister is a brave man if he introduces laws that interfere with age-old customs concerning people’s power to decree what should happen with their remains. If Gordon Brown has no intention of heralding authoritative, even harsh, legislation but has been trying to draw attention to the thousand people who die every year while waiting for a transplant, good luck to him.

Eight thousand is the usual figure quoted as the number of patients waiting for a transplant but this doesn’t reveal adequately either the real numbers involved or the suffering that they experience. Last year there were 8,602 waiting just for a kidney transplant, the most frequent and most successful organ to be transplanted. The operation cannot only maintain someone’s life but also return it to something approaching its previous quality. Also there are 96 patients waiting for a new heart, 333 for a liver and 260 for new lungs.

The need is not for more laws in Parliament but to retain the current system while persuading more people to carry a donor card, and to inform them of the power they have to offer renewed hope to others.

A campaign to increase the number of donor card carriers would be helped if the reasons for people’s reluctance to become a donor, other than the dictates of their religion, was understood. Much of it stems from two aspects of dying. Corpses and death, as well as inducing primal fear that reminds people of their own mortality, are associated with a strong taboo in most cultures against any action that appears to be irreverent or lacking in respect. The other relevant aspect is that discussion of death has focused for thousands of years on whether, if there is an afterlife, the deceased will be at a disadvantage if their bodies were not intact but scattered before burial or burnt. Theological Christian doctrine now teaches that after death the soul, provided the person has passed St Peter’s and St Michael’s stringent entry requirements, attains life everlasting. After death the body becomes no more than a redundant shell. This established teaching fails to take into account the belief that in the afterlife people will be as recognisable as they had been in life. A consoling thought exemplified in countless medieval paintings illustrates that those who have behaved themselves in this world rise from their graves, suitably fleshed out and clad, as they are reunited with their earthly family and friends.

A doctor’s detachment that stems from constant exposure to death must never be allowed to trivialise the impact it makes on those recently bereaved. Even so, surveys show that doctors, despite Alder Hey, Harold Shipman and other scandals, still enjoy the confidence of the public. It must be demonstrated that any apparent conflict of interests between doctors’ duty to the recipient and the donor won’t reflect on the care given to a mortally ill or injured person. Although a doctor may be torn between the desire to protect the sensitivities of a dying or recently deceased person’s family and to collect an organ as soon as possible after death so as to give the recipient the best chance after transplantation, everyone must be aware that this couldn’t hazard the possible survival of the donor.

The Prime Minister’s campaign should be planned to reassure everyone that transplant teams are humane, that although doctors have seen it all before, they won’t trivialise the value of the gift that donating an organ affords to others, or take for granted the sacrifices this may demand from relatives.

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