Organ Donation Opt in or Opt Out?
On October 3rd the Prime Minister announced plans to introduce an opt-out system of consent for organ donation into England (1), indicating that a consultation on the proposal would be launched before the end of the year. Dr Paul Murphy, National Clinical Lead for Organ Donation, explains why the time for such a system is right.
Opt-out systems of consent are generally associated with higher donor numbers, although demonstrating a causal link remains elusive. A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it (2), whilst a system of so-called deemed consent already operates in Wales. The Welsh system was enacted in December 2015 following an intense period of public education and professional preparation. Whilst there have been encouraging signs in consent rates, as yet none have reached statistical significance and neither has there been any demonstrable increase in donor numbers.
A consultation on a ‘soft opt out’ system in Scotland earlier in the year showed considerable support for it
There are reasons for this. Donor numbers in Wales are small and inherently sensitive to variation in the potential for donation. Furthermore, it is unrealistic to expect a change in the law to trigger a step change in public behaviours overnight. Rather, the introduction of opt-out legislation should be the point at which work to mould societal and professional expectations begins in earnest, to move it from a matter of personal choice towards one of societal responsibility.
In January 2008, the Organ Donation Taskforce published its ground-breaking report Organs for Transplant. With the ink barely dry and implementation of its recommendations just beginning, it was asked to go on to consider whether presumed consent should also be introduced. The answer, in its second report published in November 2008, was as simple as it was predictable: introducing opt-out may well lead to an increase in donor numbers, but it could equally well jeopardise implementation of its first report. The time was not right.
We have made huge improvements in donor referral and have become world leaders in donation after circulatory death…. So now is the time to make the change
The contrast between then and now is dramatic. There were 793 deceased donors in the UK in 2007; this year will be close to 1500. We have made huge improvements in donor referral and have become world leaders in donation after circulatory death. But we have made no improvements in consent and 30% of families continue to say no. We will not have a world class service, we will not rank alongside Spain, Croatia and Belgium, we will not realise the unmet need for transplantation in the UK, whilst this remains the case. So now is the time to make the change, to introduce a framework that places an expectation on the society, a framework that acknowledges the needs of families, a framework that protects the vulnerable but which challenges the free-rider. It will not be a quick fix and neither will it be a panacea, but now is the time. I think the Taskforce would agree.
What are your views on an opt-out system?
To coincide with their talks on organ donation at the State of the Art 2017 in Liverpool, Dr Dan Harvey and Dr Paul Murphy are launching an on-line survey aimed at gaining an insight into the views of the critical care community on presumed consent for organ donation. It will help inform the ICS and FICM’s formal response to the government’s consultation on the issue. The survey will take approximately 20 minutes to complete and can be found here https://www.surveymonkey.co.uk/r/ICSconsult