Organ donation is a moral not legal obligation

Donation is an act of charity that will only be degraded by making it compulsory, whilst development of the ‘opt-in’ approach preserves fundamental rights

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.

7 comments

  1. Although the ‘grief of the next of kin’ must be considered, how about the grief of the next of kin of the individual would die without an organ? Grieving families will often reject organs being taken from their loved one in the heat of the moment, even though when calm and rational they fully support organ donation.

    And rights of the deceased? Why should the deceased have rights? If someone is deceased, they no longer exist as a person. There is no organ ‘owner’.

    Perhaps we should implement John Harris’ ‘Survival Lottery’. Enter everyone into a ‘lottery’, and whenever several new organs are required, kill the person who is selected at random in the lottery. Given that people are much more likely to need an organ than to be selected, it would increase most people’s chances of survival, so we should accept it, right?

  2. I believe the entire concept of an “opt out” system is ridiculous, it’s just a way for the government to make people feel guilty about removing themselves from the register, I am currently a registered donor but if the legislation is passed I will be removing myself from the register as it, in my opinion, destroys each and every reason why I registered in the first place. I also believe that the next of kin should always have the final says because even though I’m registered I would not wish my wife’s organs to be donated as I do not enjoy the thought of her body being harvested and distributed, even after death. As people we should always have our rights even after death, you would expect your wishes outlined in your will to be followed so why not your wishes about organ donation?

  3. “I will be removing myself from the register as it, in my opinion, destroys each and every reason why I registered in the first place”

    You make it sound like you only registered to make yourself feel better, rather than because you give a damn about other people.

    “I also believe that the next of kin should always have the final says because even though I’m registered I would not wish my wife’s organs to be donated as I do not enjoy the thought of her body being harvested and distributed, even after death. As people we should always have our rights even after death,”

    What if your wife wanted her organs donated? That’s where the issue lies with allowing family the final say; families will often override the wishes of the dead person. So if you think a dead person’s wishes should be respected, the family should not be able to override that wish.

    “As people we should always have our rights even after death, you would expect your wishes outlined in your will to be followed so why not your wishes about organ donation”

    There’s a difference between rights and wishes. The point about the will is that it gives you a sense of security and confidence while you are alive. The same could be said about knowing what will happen with your organs.

    But wishing to hold onto your organs when you are dead is simply irrational and means other people will suffer unnecessarily. Perhaps it could be compared to leaving money in your will to some sort of criminal organisation that also inflicts unnecessary harm. In both cases, the dead person’s wishes are justified in being overridden.

  4. 14 Mar ’12 at 5:32 pm

    Oliver Blackburn

    If you’re not on the register you shouldn’t get organs from other people. It’s not opt-out and I daresay more people would register.

  5. “There’s a difference between rights and wishes. The point about the will is that it gives you a sense of security and confidence while you are alive. The same could be said about knowing what will happen with your organs.

    But wishing to hold onto your organs when you are dead is simply irrational and means other people will suffer unnecessarily. Perhaps it could be compared to leaving money in your will to some sort of criminal organisation that also inflicts unnecessary harm. In both cases, the dead person’s wishes are justified in being overridden.”

    This makes completely no sense i would not be creating more suffer but choosing not to help relieve suffering therefore a more appropriate comparison would be leaving money to my family who could manage without it as opposed to giving it to a charity. I’m sure most people would put their families first.

    “What if your wife wanted her organs donated? That’s where the issue lies with allowing family the final say; families will often override the wishes of the dead person. So if you think a dead person’s wishes should be respected, the family should not be able to override that wish.”

    My wife did want her organs donated but we discussed the reasons why I would prefer she didn’t and she chose to not hurt her family for a chance to save someone she or her family have never met. This is therefore her wish and I would not override her decision had she decided differently. If she wished the same in regards to my organ donation then I would do the same.

    “You make it sound like you only registered to make yourself feel better, rather than because you give a damn about other people.”

    Does it matter why people register along as they do? In my opinion this “opt out” system is one step closer to a compulsory system that would see all organs donated regardless of the persons wishes or their families wishes.

    “If you’re not on the register you shouldn’t get organs from other people. It’s not opt-out and I daresay more people would register.”

    I Agree but I also agree that people who cause their organ failure etc through fault of their own should not get replacements. I know not all alcoholics or smokers etc who have proven they have given up relapse but a substantial amount do and this therefore wastes the small number of organs available .

  6. I would also like to add that it’s a personal choice of mine not to receive a transplant either.

  7. The whole idea of the opt out system is it gives people the freedom to opt out so doesn’t infringe their rights and would bring in a lot more organs than the current opt in system.

    Every time someone signs up to organ donation they potentially save a life/multiple lives or treat a devastating affliction. I’m think that if someone saw a blind person struggling they would want to help them and they can without any loss to themselves whilst they live.

    I’m sure a lot of people agree with organ donation but not all of those are willing/get round to carrying out the action of filling out a form. If we had the opt out system, I’m sure people who didn’t want to donate would make more of an effort and be willing to cross the activity barrier in order to sign off than people are currently doing to sign up to organ donation.

    If more people joined signed up for organ donation we wouldn’t need the opt out system. This would be an ideal and could be achieved with greater publicity and more opportunities for people to sign up. Currently people a lot of people aren’t aware of how to sign up but I’m sure that if the opt out system was adopted, people would be informed of how to opt out and even if the opt out system was never used, suggestion of it in the media would still make people more aware of organ donation.

    Also James Rosser could you truly say that when you are at death’s door and the only option for life is a transplant, you would have the courage in the heat of the moment to refuse a transplant?

    There’s some really good information on both the opt in and out and other alternatives on the NHS website: http://www.organdonation.nhs.uk/ukt/newsroom/statements_and_stances/statements/opt_in_or_out.asp

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