Organ Donation in Contemporary UK Is the Concept of Presumed Consent the Best Way Forward

Organ Donation in Contemporary UK

Beginnings, Current Figures and Needs

An organ transplant may be resorted to if one body organ fails or is lost to an illness

or injury (Medline Plus 2009). Organ transplantation involves the removal of the same healthy organ from a donor and transfer to the recipient's body. The most commonly transplanted organs are kidneys, heart, liver, lungs, pancreas, eyes and small bowels (Medline Plus, Evening Chronicle 2003). Bone and tissue, such as skin, heart vales and tendons, may be donated for transplantation. Transplanted skin grafts and bones have helped victims of severe burns and orthopedic surgery patients (Evening Chronicle).

The first successful transplant was a cornea in 1905 and the oldest recipient on record in the UK was an 81-year-old kidney patient (Evening Chronicle 2003). The National Health Service Organ Donor Register lists donors, more than half of whom are between 15 and 34 years, 8% of whom are 65 years and older and from both sexes. The NHS observed that kidney failure was three times likelier among Black people who, therefore, stood in greatest need for kidney transplants (Evening Chronicle).

The Organ Donation Task Force doubled the number of its coordinators in local hospitals to cope with the demand for more donations (Duffy 2008). They were to guide and support bereaved families, who were potential donors, through the donation process. Authorities hoped that this would raise the current rate from 60 to 70%. Statistics showed that 7,500 recipients were in the waiting list. They would work at the task 24 hours with the intensive care staff to reach the goal of an additional 120 transplants in the next five years. Health Secretary Alan Johnson asked the task force to study if the UK system should change to a "presumed consent" mode. Under this mode, people would need to formally "opt out" rather than "opt in" as donors. The British Medical Association and the chief medical officers endorsed the idea. A survey conducted by the Association revealed that three-fourths of the public supported the change. Scotland sustained the suggestion. Its Health Secretary Nicola Sturgeon expressed full commitment to both an increase in the volume of transplants and the system of presumed consent. A spokeswoman for UK Transplant commented that any endeavor in the direction of increase would benefit the more than 400 who died each year because of the lack of available transplants. Medical Director Peter Weissberg of the British Heart Foundation pointed to donor availability as the limiting factor to heart transplants (Duffy).

The idea was for everyone to be a potential organ donor at death unless there was an express request not to be, according to England's chief medical officer (BBC 2009). This was the proposed system of "presumed consent. The Scottish Tories, in opposition, expressed preference for an increase of donations in the register. Shadow Health Secretary Andrew Lansley said that the state does not own people's bodies and has no right to take their organs after death. Conservatives would rather assist organ retrieval teams in hospitals and increase liaison nurses in responding to the transplant shortage. Member of Parliament Harry Burns countered that no evidence existed to assure public support of Lansley's position. The Members of Parliament rejected the system of presume consent when they voted on the Human Tissue Act in 2004. Their common position was that organ donation was a generous gift but not an obligation (BBC).

Diverse Views

Former Health Secretary John Reid and Health Minister Rosie Winterton believed that Parliament could not decide what should happen to people's bodies after death (BBC 2009). Member of Parliament Evan Harris of the kidney group who introduced an amendment to the Human Tissues Bill insisted that the government should now take a stand towards presumed consent. Sir Liam Donaldson emphasized that rousing people to register for donations had failed. While surveys said that as many as 70% of the population would donate after death, only 13 million or 20% of them were registered. He explained that the volume of potential donors needed to be much larger than recipients, then numbering 8,400. Those adding to the waiting list were always outnumbering those coming out after receiving successful transplants. The BMA endorsed his position, stating that a system of presumed consent with strict safeguards would address objections, according to Chairman Tony Calland of the Medical Ethics Committee (BBC).

Sir Liam and his supporters based their recommendations on the experiences of other countries, which adopted the system (BBC 2009). Spain doubled the volume of donors to 35 per million since the adoption in 1990. Spain observes a soft opt-out system, which allows relatives to decide if the person did not opt out in his life time. Austria initially observed a very strict system, which did not consider relatives' decision at all. But when it passed a presumed consent law in 1982, the volume of donations increased four times. Kidney transplants, for example, were almost as many as those in the waiting list. Other countries with an opt-out system are Belgium, Sweden, Denmark, Finland, France, Italy, Norway and Singapore. Sir Liam said that the proposed UK system would mostly likely not consider the decision of close relatives. It would be supported by massive public information campaign and stay in the hands of Parliament. Human Tissue Authority chief executive Adrian McNeil, on the other hand, argued that the new act had been operational for only a year. Adopting a new system would affect its provisions for fully informed consent for purposes other than transplantation. In the meantime, the opt-in system would remain (BBC).

Favoring Opt-Out

Dr. John Troyer of the Centre for Death & Society believed that the system of presumed consent would be the best way of addressing the increasing demand for organ transplants (University of Bath 2008). It allowed persons to opt out of donating their organs after their death. As of last count, 7,500 patients were in the waiting list and almost 16 million organ donors were registered. But the current law gave a patient's relatives the option on whether to donate his organs for transplant. The situation not only often ended in delay but also in refusal to donate. The current law observed an opt-in system in which donors must register their consent for use after their death. Dr. Troyer pushed for the adoption of an opt-out or presumed consent system. This system would automatically allow the use of a deceased person's organs for transplantation unless he specifically forbade it before his death. It would lead him to inform his relatives about his decision. It would, as a consequence, significantly ease the bursting waiting list of recipients (University of Bath).

According to Dr. Troyer, body parts, like teeth, nails and bones and skin for burns were being illegally and globally sold in the black market (University of Bath 2008). Kidneys have also been traded by living donors for large amounts of money. Some of them came from third-world donors who sold their organs to desperate first-world recipients. This prompted concerned sectors to seek for the regulation of the sale of body organs to discourage wrong practices and ensure fair price for the sale. Dr. Troyer, however, argued that, rather than regulating, increasing organ supply would drain the black market. Organ donation should be done only for altruistic motives, which can opt out, when preferred. This could increase the number of organs available for use and reduce the demand on the black market. At the same time, it would reduce exploitation of poor donors who sell their organs and put their own health at a risk in exchange of money. Despite a national register of potential donors, doctors cannot easily determine what organs are available for transplantation. The overall problem is that the British are not comfortable discussing death (University of Bath).

A recent BMA survey showed that around 800 Scots needed donor organs and many die without obtaining these organs (Hutcheon 2007). Almost 75% of them now support the system of presumed consent, representing a 10% increase since the 2004 BMA survey. First Minister Alex Salmond and his deputy, Nicola Sturgeon, expressed the same stand. Their position would enhance that of Sir Liam Donaldson who considered organ shortage in Britain so critical as to warrant a change of system (Brophy 2007). Those who would opt out must register their decision. Those who would donate were made to carry cards. Donaldson's position would consider the preference of the person's family. Records showed that 7,234 were in the waiting list or 8% higher than those in the previous year. Those who received transplants reached 3,074 or 10% higher than the preceding year. It was also the highest recorded to-date. With 1.1 million more added to the NHS organ donor register, there were 14.2 million by the end of 2006/70 (Hutcheon).

Infection in Organ Transplants

A recent study on 223 solid organ transplantation or SOT patients at the Mayo Clinic revealed that they had a higher risk of contracting gram-negative bloodstream infection than theā€¦