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Thursday, 6 August 2009

Action not words now needed on organ donation

Around 30* people will have died in Wales in the last year, waiting for a transplant on the organ donor register.

That's why BMA Cmyru Wales is calling for action to be taken by the Welsh Assembly Government with regard to possible changes to the organ donation system.

It’s also a year since the Assembly’s Health Committee rejected any ideas to change the organ donation system in Wales.

This led to the Welsh Assembly Government’s wider consultation on the matter, which has just closed.

We submitted a response to this consultation, reiterating calls for a “soft” system of presumed consent to be introduced and to do so sooner rather than later, before more lives are lost.

There are several reasons why the BMA believes that such a system would produce a far higher potential donor rate than at present and in turn, save more lives.

The main difficulty with the current system is that where, as in the majority of cases, relatives do not know what their loved ones wishes are, they frequently, and understandably, opt for the default position, which is not to donate. This would be addressed by the introduction of an opt-out system where the default position would change in favour of donation. We recognise this is a subject many people hold strong views about and as such, those who do not want to donate their organs will sign up to opt out.

The number of people on the organ donor register has doubled since 2001, from 8 million to more than 16 million. But the gap between the number of organs available and those needed continues to grow, with around 1,000 people dying each year in the UK waiting for an organ.

Presuming consent rather than presuming objection is also more likely to achieve the aim of respecting the wishes of the deceased person. Given the very high level of support for organ donation expressed in repeated surveys (up to 90%) it is reasonable to presume that those who die without making their views known are in the majority who want to donate, rather than the minority who do not. With such a shift towards making donation the default position this reflects a positive view of donation, demonstrating the very strong support for it within society. Therefore, over time donation would come to be seen as the norm, rather than the exception.

Added to this is the fact that there is significant and growing public and professional support for such a shift. Recent public opinion polls show around 60-70% support for a shift to an opt-out system of consent for organ donation. This is consistent with the views found in the Assembly’s own public engagement exercise.

The time really has come, before more people die waiting in vain, the Welsh Assembly Government needs to stop procrastinating and seek an LCO (Legislative Competence Order) from Westminster to bring in a soft system of presumed consent.

*The figure of 30 people dying in the past year in Wales is based on 150 people dying in Wales waiting on the organ donor register in the last 5 years.


  1. Richard Aspinall11 August 2009 at 23:34

    This is an utterly misguided policy - what efforts have BMA Wales made to consult with members, not to mention specialists in the field? An opt-out policy would see recently-bereaved relatives forced to see their loved ones' organs being harvested against explicit consent. It would create genuine hostility to our much-valued transplant programmes. I do not know of a single doctor involved in transplantation who supports such a scheme. The way forward is through a system of having trained organ donation specialist counsellors in every hospital - this is how Spain has achieved the highest per capita donation rates in Europe. The BMA have got this policy completely wrong.

  2. Richard,

    Thanks for your views on what is an emotive and controversial subject for many.

    I think it important to address some of your points here and reiterate why the BMA feels very strongly about this policy.

    The BMA supports an opt-out system of soft presumed consent for those over the age of 16, where relatives’ views ARE taken into account. As an added safeguard, if the individual had not registered an objection, the relatives would be asked if they were aware of any unregistered objection. If there is no known objection, the intention would be to proceed with donation. However there should be scope not to, if it is clear that doing so would cause severe distress to the relatives.

    Unlike the current system, there would be a clear mechanism for protecting the wishes of those who do not want to become donors. There is no opportunity at the moment for someone who does not want to donate to register those views and ensure they are respected. This means that relatives may be giving consent when the individual would not have done so.

    In its summary the UK Organ Donation Taskforce reported, as one of the arguments in support of a shift in legislation of the “apparent correlation between high donation rates and opt out systems in countries around the world”. The BMA also supports many of the Taskforce’s recommendations, including an improved transplant infrastructure with trained counsellors, which you also point out as being important.

    The number of people on the organ donor register has doubled since 2001, from 8 million to more than 16 million, but the gap between the number of organs available and those needed continues to grow. Around 1,000 people die each year in the UK waiting for an organ. The BMA believes a change in legislation could make a real, tangible difference to these rates.

    The BMA is also a democratic organisation, formulating policy based on members’ views debated and voted on at its Annual Representatives Meeting. This is what happened with presumed consent in 1999. And it was reaffirmed at the BMA’s Annual Representatives Meeting in 2006 and 2008.


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