Opt-out proposal for organ donation presumes consent

The system preferred by Holyrood is not informed choice, says Anthony Horan

The Scottish Government’s public consultation on organ and tissue donation and transplantation, examining whether a soft opt-out system for Scotland should be considered, ended in March. The Scottish Government has suggested we move to a system of presumed consent (or opt-out) where, unless you state otherwise, it will be presumed that you wish your organs to be removed on death.

Coincidently, figures showing a sharp rise in organ donations and transplantations were released by the NHS in April. They show that 2.4 million people, almost 45 per cent of the population, are now registered donors, while the number of people waiting for a donor organ has fallen to the lowest level ever. encouraging figures follow a high-profile campaign urging Scots to become donors.

They also seem to contradict the government’s assertion that a new “opt-out” rather than the current “opt-in” system is the only way to increase the donor base.

Opt-out systems are legal systems enabling persons to instruct their organs not be removed for transplantation after death (for example, by informing relatives or joining a register), while the organs from all those who have not left such instructions can be used. With soft opt-out systems, nearest relatives have a final say about the removal of organs.

Supporters of the opt-out system believe it will solve the problem. Evi- dence from around the world suggests it probably won’t. Spain has significantly higher rates of organ donation than Scotland, although an opt-out system has operated for decades and opting out is very easy. However, it wasn’t until Spain decided to proactively encourage organ donation in 1989 through a national public campaign and the creation of the Organización Nacional de Trasplantes (ONT) as part of the Spanish Ministry of Health that donor numbers increased.

It did this by relying on designated professionals and coordinators based in every hospital who were responsible for organ donation. This coincided with a greater focus on education and a massive advertising campaign to highlight the importance of organ donation. These changes worked and they thrust Spain to the forefront of organ donation across the world.

We can learn from the Spanish example and potentially avoid an opt-out system of presumed consent, which denies individuals the right to make an informed choice about organ donation.

It is vital that those whose organs are removed are given all the information necessary to allow them to make a positive, well-informed choice about what they would like the state to do with their organs on their death. Presumed consent effectively means the state taking ownership of its citizens’ organs unless the citizen decides otherwise. What the effective Spanthese

ish system shows is that it is not through moving to a system of optout but rather it is about implementing and supporting bold and positive organisational change that improvements will come.

Here in Scotland we could take the best of the Spanish system and use it to the advantage of those most in need. Starting from the basis of the existing opt-in system, we can develop the way we manage organ donations, ensuring that there are suitably qualified personnel in every hospital committed to organ donation as well as undertaking a positive, eye-catching public awareness campaign through the media.

If we do this, then there is no reason why we cannot experience the same significant increases enjoyed in Spain. The current Human Tissue (Scotland) Act 2006 was drafted, among other reasons, as a response to the Alder Hey Children’s Hospital scandal in Liverpool in the 1990s, when body parts of children were retained for biomedical research after post-mortem examination because healthcare professionals presumed that this would be acceptable to parents without consultation.

This means that the Alder Hey scandal came as a direct result of what was supposed to be a soft optout system in which silence represents authorisation. But this quickly became unethical when healthcare professionals did not make “reasonable enquiries”.

Obviously, high profile awareness campaigns and organ coordinators cost money, while simply switching to an opt-out system doesn’t, but with lives at stake, we should be willing to invest in proven models which lead to the outcomes we’d all support. l Anthony Horan, director, Catholic Parliamentary Office JOIN THE DEBATE www.scotsman.com