So, the Organ Donor Taskforce has rejected the Government’s proposal of introducing a system of presumed consent to increase the number of organ donors. I have to say my personal view, as a trainee transplant surgeon, is that presumed consent is a bad idea. The recent surrounding publicity will certainly have left some members of public confused and potentially distrustful of doctors’ motives when it comes to organ donation.
The fundamental issue is that as a nation we just don’t seem to have engaged with the concept of our organs being used after death. Only 26% of the population are on the organ donor register (you can register here). Is this number so low because of cultural, religious, or ideological reasons? Or is it that we just can’t be bothered to register? Perhaps the main reason is that for the majority of people, life is just too full of immediate real problems to consider the hypothetical question of whether you want to donate your organs if sudden death occurred. Of course no-one really believes they will die or end up on intensive care during their prime. However, it does happen to thousands of young adults each year in the UK. So how do intensive care units manage such “potential organ donors”? UK Transplant has been collecting data on potential donors for some time – its latest report is available online.
£4.5 million is going to be spent on a campaign to raise awareness and double the number on the register by 2013
It appears that units could do better at identifying and approaching potential donors (at least 10% of brain stem dead patients and nearly two-thirds of potential non-heart beating donors are not considered). In addition, when an approach is made about donation, about 40% of relatives often refuse consent. Ethnicity does appear to be one factor in consent; with rates of refusal of 32% in white potential donors and 74% in non-white potential donors.
So do we need a change in the law? Since 1997 there have been 2,685 new laws passed per year – so Whitehall’s solution to the mismatch between the growing number of patients who could benefit from a transplant (7,926 on the waiting list at the last count) and the static number of donors after death (about 800), is of course – “a new law”. Would “presumed consent” achieve its aim?
I wonder if the Government would make it as difficult to opt out as it is to get Family Tax Credits. Would less people actively opt out than are currently not bothering to sign up to the donor register? Perhaps the Government believes we are all so ambivalent that no-one would complain about taking organs after death (unless we have explicitly remembered to say no during life) as we are too busy trying to pay the mortgage. Have they forgotten the Alder Hey scandal?
More co-ordinators, based in ICUs not transplant units, will really help raise awareness within their critical care units and the hospitals which they will serve
The irony is that we have only just had a new law to stop the bits of us that are no longer attached from being used for anything we didn’t consent to, and at the time it also adequately updated the law on organ donation. The Human Tissue Act (2004) came into force just over 2 years ago and provided key changes to the legislation relating to organ donation, particularly consent. Prior to the Act, carrying a donor card or registration with the Organ Donor Register (text ‘Give’ to 84118) was less binding a commitment to organ donation than a premiership footballer’s contract with his club during a transfer window. If your relatives did not give consent you did not become a donor; simple as that. The Act has changed all that - relatives no longer have a legal right to overrule those wishes, and registration with the Organ Donor Register (phone 0845 60 60 400) does itself provide consent for donation.
So instead of a new law, £4.5 million is going to be spent on a campaign to raise awareness and double the number on the register by 2013. Given that the average kidney transplant lasting 10 years saves the NHS £241,000 over that time; the money will prove to be a sound long term investment if an extra 10 donors with two kidneys each are produced. Changing attitudes in society towards organ donation takes time and perhaps it is unrealistic to expect immediate effect from shovelling cash into an advertising market full of retailers desperate for our money.
To my mind however, the part of the Organ Donor Taskforce strategy that is likely to bring about a change in donation rates is the recruitment of 63 new donor co-ordinators. Spain has the highest organ donor rate per million of population in the world for two reasons: firstly society has a positive attitude towards donation and transplantation, and secondly because there is a donor co-ordinator on every intensive care unit. Co-ordinators in the UK are already providing fantastic support to potential donor families and critical care workers. Furthermore, one of the key day to day roles of a donor co-ordinator is to educate. More co-ordinators, based in ICUs not transplant units, will really help raise awareness within their critical care units and the hospitals which they will serve. These changes in infrastructure in conjunction with the changes in the law brought about Human Tissue Act could have a huge impact on organ donation. We just need to give them time. If the 10% of “missed” potential donors became actual donors (assuming a 60% consent rate) there would immediately be an extra 85 donors a year (that’s £45 million saved over the next 10 years, just for the kidneys).
But no matter what anyone says it’s not about the money. Last year approximately 1000 patients died waiting for a transplant. That’s why we need more donors – so go on register. It sounds glib but transplants save lives.