The ratio of organ donors to recipients has been a problem in the UK for years, with what sounds like a staggering 18 million people registered. Yet the demand is still not being met. More than 10,000 people in the UK are currently awaiting transplant, and it is estimated that each year more than three a day die before an organ match cannot be found. Numbers on the Organ Donation register have seen a 25 per cent increase in recent years, but clearly more must be done to mobilise the apathetic to register.
As a result of these concerns the British Medical Association has suggested the introduction of an “opt-out” system of organ donation, to remove the possibility of families refusing donation out of ignorance of their loved one’s stance on the issue. Currently, 43 per cent of bereaved families refuse to allow donation because it has not been declared one way or another. The “opt-out” system would presume consent unless the individual had actively declined, thus stripping the family of their legal authority over the fate of their loved one. A bill introducing a form of “opt-out” donation policy is set to enter the Welsh Parliament this summer, and is likely to become legislation by 2015.
But concern must be held for the rights of the deceased and for the grief of their next of kin. To assume consent, instead of encouraging the generosity of actively signing up is surely wrong, especially given individual preferences and religious observances. In assuming consent it is implied that organs are not the full property of the owner, but a material need for the state, commodifying organ donation.
While almost a third of people in the UK are now registered, the UK transplant service has set a target of a 50 per cent increase in willing donors by 2013, an implausible target without legislation of this kind, but a necessary increase to help save those 10,000 lives. Donation should be seen as an opportunity to give something back to society, and to benefit or save the life of another person, through an action that does no harm to yourself. A study by the Organ Donation Taskforce showed that while the public generally are open to the possibility of organ donation, with only about 14 per cent of people being wholly against joining the register, the main problem was the lack of awareness and clarity. Increased publicity of signing-up is needed, rather than just an option tacked onto the provisional licence application form.
“concern must be held for the rights of the
deceased and for the grief of the next of kin”
There is no clear choice, and there are many other different strategies that may be put into place, such as mandated choice or incentives. Mandated choice, where people are forced to make a decision but there is no presumed consent, seems a far more acceptable way to meet targets. But the incentives scheme is just as grating as a “hard opt-out” system – it suggests the possibility of those on the donor register being higher up on transplant lists if they themselves are ever in need, degrading the generosity of individuals to seemingly a selfish pursuit of health security.
The number of willing donors must increase to save lives, but this comes into conflict with the moral values of society. An “opt-out” system implies that the organs that sustain you and that you were born with are not your property unless you actively claim them. In place of this bill, and as suggested by the Organ Donation Taskforce, surely an improved opt-in system would be more acceptable, where education and encouragement are the key factors in increasing consent.
The number of people on the Organ Donation Register has seen a “staggering” increase within the last five years, a trend that hopefully will only increase as the blood and transplant service spread awareness for the need. Rather than risking the Brazilian mistake of legislative reversal after the public alienation caused by their “opt-out” system, let us first attempt to improve the awareness and effectiveness of the “opt-in” system and save ourselves from hurriedly implementing a policy likely to create a public backlash that is mired in religious and ethical objections.