Opt-out systems abroad prove successful in increasing transplants
ANYONE waiting for a life-saving organ will surely welcome the move to presumed consent, which not only brings Scotland into line with Wales – the UK’s trailblazer – but also much of Europe, including Norway, Finland and Spain.
Evidence consistently shows that countries with opt-out laws have donation rates 25 to 30 per cent higher than those in countries requiring people to pro-actively sign up to a donor register. In Wales, 160 organs were transplanted during the first 12 months under the opt-out regime – introduced in December 2015 – of which 39 were obtained through presumed consent.
The decision to adopt a “soft” opt-out, which means next of kin still have to right to overrule organ donation after their loved one dies, is probably the right approach given that previous efforts to change the legislation in Scotland have failed.
In Singapore, for example, opt-out is coupled with a priority rule which incentivises citizens against opting-out on the grounds that they will then be relegated to “the back of the queue” if they should end up requiring a transplant themselves. The system boosted the number of kidneys becoming available for transplant more than six-fold within three years, but it is difficult to see such a policy gaining popular support in Scotland – at least for now.
It is important to realise, however, that availability of organs is only part of the transplant puzzle.
A major global study in 2008 found the ratio of transplant centres to population was the biggest single factor behind a country’s transplant rate.
That is why Peter Bennie, chairman of the BMA in Scotland, was right to stress that delivering opt-out successfully in Scotland depends on “adequate resources and staff”.
Scotland may not necessarily require more transplant centres – after all the organs retrieved for donation in Scotland will be transported to wherever they are most urgently needed anywhere in the UK – but it will be vital to ensure that we have the right number of transplant surgeons, theatre staff, and critical care beds to cope with any rise in transplants. It would be a tragedy if any organs were wasted due to staff or bed shortages.
The BMA also stresses that it may take two to three years to have suitably “robust” new database in place, and that its roll out must be accompanied by “widespread, high-profile publicity” on how to opt out.