Today, the second reading of the Organ Donation (Deemed Consent) Bill will take place in the House of Lords. Ahead of this, we have released the following statement: Hugh Whittall, Director of the Nuffield Council on Bioethics said: "The Nuffield Council on Bioethics strongly supports organ donation where it is in line with people’s wishes. We are concerned that the positive benefits of a legal change to opt-out are being overplayed on the basis of current evidence.
Statistics so far from Wales are inconclusive as to whether changing to an opt-out system actually increases the number of transplants. Evidence is clear however that public awareness to support discussion amongst families, and support for bereaved families such as specialist nurses for organ donation, are critical factors. Whatever legal system you have, it is vital that the Government are willing to invest in maintaining constant public awareness to support family discussion of organ donation; and in the infrastructure and resources needed to support sensitive conversations at the point of bereavement. We are concerned that unless the right resources are put in place, any opt-out policy will fail."
There are three issues that need serious consideration before any “deemed consent” for organ donation can be considered truly ethical. These are:
1. A well-informed public and the importance of discussing wishes – it is vital to have measures in place that encourage people to express and document their wishes about organ donation during their lifetime. It is not enough to focus on a public information campaign at the point when the law changes: effort (and resource) will be required on an ongoing basis to ensure that the public remains well-informed.
2. Family involvement and support - families must stay at the heart of the decision-making system. This is clearly recognised in the Spanish system (which has very high donation rates), which is often held up as a shining example of the success of ‘opt-out’, but in fact does not maintain any kind of opt-out register, and in practice, depends entirely on family consent. Investment in training specialist nurses for organ donation is integral to this – evidence shows that family consent rates rise from as low as 22% where no such support is available, to 70% when a specialist nurse for organ donation is present.
3. Trust in the organ donation system – if public trust in the system is undermined, there could be potentially serious consequences for organ donation. Any change to the donation system needs to be designed in such a way as to minimise the risk of any loss of trust.