Wednesday, July 3, 2013

Presumed consent for organ donation is both unnecessary and unethical.

The following article only concerns the issue of presumed consent for organ donation. 

Dr Saunders does not comment on issues related to the abuse of organ donation, the abuse of the dead donor rule, and the redefinition of when it is appropriate to remove organs.

Sadly the presumed consent organ donation bill passed on July 3 in Wales.

Peter Saunders
By Dr. Peter Saunders - July 2, 2013

Wales could become the only UK country with an opt-out organ donation system if politicians vote to change the law today.

Currently an ‘opt-in’ consent system operates across the UK.

Individuals can authorise organ removal from their bodies after death by joining the Organ Donor Register (ODR), or making their wishes known to their family.

However the Welsh government wants to introduce new legislation which would authorise doctors to remove organs and tissue from any patient declared dead, unless the deceased had formally registered their objection.

I strongly support organ donation but so-called 'presumed consent' involves neither consent nor donation – it is neither voluntary nor informed and involves taking organs rather than giving them.

It means effectively that the state will be able to overrule families and there is a very real danger that it could also prove counterproductive and undermine trust leading to fewer rather than more donations. Introducing this legislation would be a radical new step, which is both unnecessary and unethical as a way of increasing organ donation rates.

The claim that donation rates could increase by up to 30% through presumed consent legislation is disingenuous as there is little evidence that this is any better than other schemes in other countries, and there are alternative ways of increasing donation rates.

Donation rates in countries with ‘presumed consent’ laws do not actually differ from countries requiring explicit (opt-in) consent. In fact, some countries operating presumed consent systems have lower rates of organ donation!

Differences in rates are due to other factors including the numbers of potential donors, provision of intensive care facilities, end of life care, use of transplant coordinators, trust in the donation system and trust in the medical profession (particularly those treating dying patients) (See here for a BMJ article on this).

Organ donation is a generous gift. It resonates strongly with the Christian principles of sacrificial generosity and love for one’s neighbour. However, consent to organ donation should always be voluntary (un-coerced), informed and autonomous. 

As Patient Concern has warned: ‘Assurance that every citizen would hear of the new law, understand it, realise its implications, grasp how to opt-out and get around to doing so – if they wish – is pure fantasy.'

The groups least likely to express their views, if they hold views on this, will include those who are disabled, less well educated or informed, lacking full capacity, of different languages and race, suffering from mental illness, dependent, those who have less ready access to information and those changing their minds. Silence in many of these cases would and should not amount to consent to donation under an opt-out system.

Organ donation should be encouraged as a gift, but this system lays the framework for the taking of organs as a right. That is a very dangerous precedent indeed.

Although this specific legislation is only for Wales, there is increasing pressure to bring in similar legislation in England and Scotland. So it is not just an issue for Wales, it is one that the rest of the UK may well soon be considering.


This is why it is so important that the Welsh government rejects this measure today.

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