According to the BMA report “Building on Progress: Where next for organ donation policy in the UK?”, people will still continue to die needlessly whilst waiting for an organ transplant, even if the Organ Donation’s Taskforce target for 2013 of increasing the number of donors by 50% is met.
The report, produced by the BMA’s Medical Ethics Committee as part of its continuing work on organ transplantation, recognizes that since the publication of the Organ Donation Taskforce report four years earlier, the UK’s organ donation system has seen substantial improvements and major changes. Nevertheless, it also underlines that achieving the 50% target by 2013 remains an important challenge, which even if achieved, will still result in people dying unnecessarily whilst waiting for an organ transplant.
According to the report, efforts to maximize the effect of the current changes should continue alongside looking for new ways for improvement, with the BMA stating that it needs a public debate to consider what more can and should be done.
Dr. Tony Calland, chairman of the BMA’s Medical Ethics Committee, declared:
“We are at a crossroads in terms of public policy. As a society we need to decide whether we should accept that we have done all we can or whether we should move forward, cautiously, and look at other options for increasing the number of donors.
There needs to be a public debate on what will work for the UK so that people on the transplant list do not die waiting for a donor. These are complex issues that throw up many ethical challenges. It is important that society discusses them openly in a reassuring way. The aim here is to save lives while at the same time protecting individual rights and autonomy.”
He continues saying:
“While our report explores a number of options the BMA continues to believe that an opt-out system with safeguards is the best way forward for the UK.”
The report shows details of a number of proposals that could increase the number of available donors under the current opt-in system. However, some pose important ethical predicaments, for instance, using organs from ‘higher risk’ groups like older people. The report states that the risks and benefits would have to be carefully weighed up against each other when using higher risk donors and patients’ would need to be made aware of these.
Other organ donor systems that have been recommended to increase the number of available donors have also come under review in chapter five of the report, with some of these already being piloted in parts of the UK.
Others include paying the funeral expenses for registered organ donors whose organs are donated after their death or a prompted choice which could expand the driving license scheme with individuals being asked to answer a question about organ donation or introducing an opt-out system with safeguards, also known as ‘presumed consent’. Each option is described in detail before the BMA offers its view on whether or not the Association supports it.
After careful consideration of all alternatives available under the reviewed evidence, the BMA is still certain that an opt-out system would provide the best option for the UK and would most likely have a positive effect on donation rates.
The BMA acknowledges that the Organ Donation Taskforce came to a different conclusion in terms of the potential impact of the opt-out legislation and states that there are other ways of increasing donor rates, arguing that it is difficult to show a direct causal association between opt-out and donation rates. However, according to the experts’ review from the University of York on behalf of the Taskforce, “the available evidence suggests that [opt-out] legislation is associated with an increase in organ donation rates.”
The BMA continues to argue that an opt-out system would only function providing appropriate safeguards are in place, that the system enjoys public support and that more public debates must take place. The BMA hopes that this report will assist in simplifying the debate.
Dr Calland commented:
“It is encouraging that the Welsh Government is planning to publish a draft Bill introducing an opt out system for people resident in Wales by the summer of 2012. It will be interesting to see how this progresses and what the UK can learn from what is happening in Wales regarding organ donation.”
Written by Petra Rattue