Soft opt-out system for organ donation runs risk of serious mistakes

I NOTE Helen McArdle’s comment piece relating to the decision by the Scottish Government to introduce a soft opt-out system for the removal of organs for transplantation (“Opt-out systems abroad prove successful in increasing transplants”, The Herald, June 29) and have several points I wish to make.

With soft opt-out systems persons can instruct that their organs not be removed for transplantation after death (for example, by joining a register) while the organs from all those who have not left such instructions can be removed, though nearest relatives have a final say.

However, with this system, there is a very significant risk for serious mistakes.

This is because when the deceased has not left any instructions (including to his or her relatives) about the removal of organs for transplantation, and relatives give their authorisation for them to be removed, there is no certainty that this is a true reflection of the real wishes of the person at the time of his or her death. The opt-out system could, therefore, damage public confidence in the transplantation system.

Of course, everything should be done to increase organ donation in Scotland and save lives. But undermining medical ethics in order to try to increase the number of available organs is only likely to eventually reduce, in the long term, the donation rate.

It should also be noted that the latest 2017 evidence shows that the soft opt-out system in place in Wales (since December 2015) has not fulfilled expectations, with deceased donor organ transplantation rates actually decreasing from 158 organs in 2013/14 to 135 in 2016/17. Indeed, it has never been demonstrated that opt-out systems, in themselves, have increased organ donation in contrast to transplantation organisation structures.

Spain is leading the world in deceased organ donation. But although the opt-out system had been in place since 1979, in this country, organ donation rates remained low until changes to the organisational structure were made in 1989.

Finally, it should be emphasised that Scotland already has a form of soft opt-out system alongside its present system. Section 7 (1) of the Human Tissue (Scotland) Act 2006 states that if the nearest relative has no actual knowledge of the adult’s wishes and there is “no authorisation by the adult ... of removal and use of any part of the adult’s body for transplantation, the nearest relative of the deceased adult may [still] ... authorise the removal and use of any part”.

Dr Calum MacKellar, Director of Research, Scottish Council on Human Bioethics,

15 North Bank Street, Edinburgh.

IT matters not how many increases in salary for nurses are given (“Row over cuts as 1,600 nurses training places to be created”, The Herald, June 29). Until we cut back the top-heavy management in our hospitals and reinstate the three-tier system of qualified staff on the wards there will continue to be untold pressure on nurses to perform to their best ability for the good of the patient.

When I became a state registered nurse in 1983/4 a ward had a complement of a senior nurse (Sister), staff nurses, enrolled nurses (ENs) and auxilliary nurses.

It was later in the 1980s that the whole swathe of the essential ENs was dispensed with to allow for the brand of managers to come in and “improve” the running of the NHS hospital.

Alas, the canteen was given out to private tender plus the cleaning, the latter falling seriously below previously high standards.

Considering the strictures having been placed upon them, staff have been doing a tremendous job to bear the load. However, more pay is not going to relieve the intense pressures some nurses are experiencing nor the quality of job satisfaction.

Janet Cunningham, 10 The Woodlands, Stirling.