Should the UK change the organ donation system?

In the UK, we currently live in an opt-in organ donation system where individuals must express their willingness to give organs after their death. This law has regularly been challenged in the last years as health professionals often catch the public attention about the lack of transplant organs.

The British Medical Association (BMA), transplant surgeons, and advocate groups would like to operate a shift towards "a presumed content" or "opt-out system." This alternative system would possibly guarantee a higher number of donors since everybody could potentially become a donor after their death unless they deliberately express their desire not to donate organs.

As stated on the Welsh government website, Wales will become the first UK country to adopt "a soft opt-out system" seeking the relatives' opinions in 248 days. This new law applying to the Welsh citizens from December, 1st 2015 may save a handful of lives while "36 people died in Wales whilst waiting for an organ transplant between 2012 and 2013." We cannot forecast the outcome of the Human Transplantation Wales Act, but the Welsh experience is worth considering for the other UK countries.

Experience in other countries

Organ donation laws are not the only factor impacting organ donation rates.

Indeed, Sweden with an opt-out system has a lower donation rate than the UK according to the National Health Service website. Contrary to "a hard opt-out law" ignoring the relatives' opinions observed in countries such as Austria, "soft opt-out laws" in Spain or Wales are often more successful. Spain exemplifies a virtuous opt-out system centered on the potential donor's family feelings. A comprehensive national procurement system coupled with a well-trained staff increased the organ donation rate from the 1990s onward. In order to boost the organ donation, a thorough training and qualities of empathy, listening, and respect are essential to help the families making a decision.

What are the arguments for and against a new opt-out system across the UK?

First of all, we can simply state that changing the organ donation law would be designed to fill a need.

NHS Blood and Transplant claims "more than 10,000 people currently need a transplant." Even though a large majority of questioned people say they would be willing to donate their organs, only about a third have joined the organ donation register. Adopting a presumed content would eventually save hundreds, if not thousands of lives. Besides, settling the issue of organ donation before a relative's death would be extremely beneficial to relatives and families. Leaving the choice up to the donor is more respectful and fairer. After all, people should be able to decide for themselves before their death if they want to donate their organs. Their relatives are not entitled to make such a decision or may not know their dearest wishes.

The government and lawmakers should also play their roles by launching a debate about organ donation within families. Communication campaigns in the media may help people understand the intricacies and consequences of the law.

On the other hand, the issue is more complex than just looking at the consent side. Road deaths along with different attitudes to the disposal of bodies and provision of intensive care beds are major factors in organ donation rates. Presumed consent may be characterized as a state intrusion. We would no longer own our bodies unless we opt-out. The state would freely dispose of our corpses. Opt-out donation laws are also controversial as they remove power from the families' hands.

Ignoring their wishes could create some tensions with doctors therefore altering trust and communication between both parties. Who should have the final say between the deceased and remaining family who make decisions in the person's best interest? Moreover, families are often well aware of their relatives' medical history. Such information is essential for the doctors to make the best decision possible minimizing potential risks.

In summary

I urge the UK to adopt "a soft opt-out system" paying attention to the families' opinions. Unfortunately, all the people who are waiting for a transplant won't be saved with a new law. Organ transplant processes follow strict procedures. Changing the people's perception on organ donation while creating a nationwide debate is an essential first step towards a more hopeful future for thousands of lives.

NHS Blood and Transplant answers most frequently asked questions on organ and tissue donation on the Organ Donation website.

European Day for Organ Donation for Transplantation is celebrated on October, 11th.