British PM Opens Debate On Presumed Consent Organ Donation

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Main Category: Transplants / Organ Donations
Article Date: 14 Jan 2008 - 3:00 PDT

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British Prime Minister Gordon Brown wrote in the Sunday Telegraph yesterday that the UK's organ donor system is in need of an overhaul, and introduced the idea that perhaps it should be based on presumed consent, where everyone is automatically a donor, and when they die their organs are presumed to be available for donation, unless they opted out while still alive.

The pressure for this reform comes from the fact there are more than 8,000 people in the UK waiting for a new organ, but only 3,000 transplants are performed every year. More than 1,000 Britons die every year waiting for a new organ.

The Organ Donation Task Force is due to report its findings this week. They are expected to announce that the infrastructure of the system is inadequate and there aren't enough donor coordinators.

However, the PM said in the article the figures showed there was an urgent need to increase the UK's organ donor pool, and took the opportunity to open the debate around whether the system should be opt in or opt out.

Brown said he wants to start a debate in the UK about whether the country should move toward a system that better reflects the fact that the vast majority of the population is in favour of organ donation. He has asked the Task Force to start a public consultation exercise on moving toward a presumed consent system.

The success rate of donor systems is measured by the number of donors per million of the population. Spain, which has a presumed consent donor system, has the highest in the world, at 34 donors per million of population. France, which also has an opt out system, has 22 donors per million of population respectively.

However, the UK, which currently has an opt in system, where your organs can only be used on your death if you and your family give permission (such as you carry a donor card and the doctors also ask your next of kin for confirmation), has a low 13 donors per million of the population.

This translates to 14.9 million people on the organ donor register, or only about 24 per cent of the population. A figure that contrasts sharply with the results of a recent survey where 90 per cent of Britons said they were in favour of organ donation. So Brown is saying, how do we get the other two thirds of the nation, who are in favour, to become organ donors?

The Task Force is due to report on Wednesday, and is expected to announce that every hospital should have a donor coordinator who explains to the families of the deceased how their relative's organs could be used for the benefit of others.

At the moment, the situation in the UK is that one third of families refuse to allow their loved one's organs to be used, even when the deceased was a donor card carrier.

The Task Force, which was set up by Health Secretary Alan Johnson, is expected to make 14 recommendations, including more experts that specialize in organ and tissue recovery, and having 24 hour transplant teams.

The conservatives have said they are against an opt out system, while the Liberal Democrats are in favour. And in 2004, Gordon Brown himself voted against it.

The presumed consent issue is a hot political potato, and already various bodies have started speaking out against it. Patient Concern, a group that promotes independence for health service consumers, said it is not up to the State to decide what happens to people's bodies when they die. Joyce Robins, who represents the organization, told BBC Radio 5 Live that a system based on presumed consent turned volunteers into "conscripts" and this was not a solution to the problem of donor shortages.

Perhaps she has a point. As Brown himself states in the Telegraph article, the United States, which has a similar opt in system to the UK, manages to have 25 donors per million of the population, nearly double the UK figure, suggesting that improvements are possible in the UK system without changing to presumed consent.

The debate appears to hinge on two aspects: is it possible, for instance by making the current opt in system more effective, to significantly increase the UK donor pool, or will only a change to opt out make the necessary increase possible?

Let us hope the public consultation exercise addresses the intricate complexities of the two parts of this debate, and does not reduce it to a single, highly emotive, political point.

Sources: Sunday Telegraph, BBC News, Channel 4 News, Patient Concern website.

Written by: Catharine Paddock
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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