Presumed consent for organ donation: a clinically unnecessary and corrupting influence in medicine and politics

Abstract

Presumed consent is a legislative framework in which citizens must place their name on a national opt-out register, otherwise their consent for donating their organs will be presumed. The Welsh Assembly last year passed legislation to enable the introduction of presumed consent in Wales in 2015. The issue is currently being discussed in Northern Ireland, Scotland and the Republic of Ireland. However, there is scant evidence that presumed consent will be effective. Rather than legislating for consent of donors, we should be addressing the misgivings and misunderstandings of families to improve their consent rate, as has been done so successfully in Spain. National improvements in infrastructure in the UK have resulted in an outstanding 63% increase in deceased donation since 2007. If, now, family consent rates could be improved from the current 57% to Spanish levels of 85%, the UK's donation rate would be one of the best in the world. KEYWORDS: Presumed consent, organ donation, transplantation, Organ Donation TaskforcePresumed consent for organ donation is a powerful tide driven by a curious mixture of good intentions, ignorance and uncritical zeal. The mantra is that presumed consent will quite obviously improve the organ donation rate and save lives. It is a heroic banner for politicians and journalists, and a desperate rallying cry for those who are themselves or whose loved ones are suffering and dying for lack of donor organs.It is a hugely emotive issue. In 2007, the prime minister Gordon Brown considered presumed consent the foundation for his 'transplant revolution', and the columnist Polly Toynbee in January 2008 regarded the argument for presumed consent as a 'fi ght with the forces of superstition and reaction'.1 Recently, Jo-Anne Dobson, a member of the Northern Ireland Assembly, introduced a Private Member's Bill for presumed consent. 3 This ongoing and absolutely remarkable achievement has transformed organ donation in the UK, of course without presumed consent.The credit for this transformation lies with the Department of Health's Organ Donation Taskforce, chaired by Dame Elisabeth Buggins and comprising 15 experts including transplant surgeons, intensive care physicians, nurses and administrators. In January 2008, the Taskforce issued an ambitious report entitled Organs for transplants. 4 It contained 14 specifi c recommendations, mainly in the area of transplant coordination (eg the early identifi cation and referral of potential donors) and the retrieval of donor organs. It also made the bold prediction that a 50% increase in donation was possible over 5 years. To the Department of Health's great credit, the recommendations were implemented throughout the UK, and the predicted increase has been not only achieved, but exceeded.In 2013, the UK donation rate, ie the number of donors per million of population (pmp), was 20.7. The country with the world's best donation rate does not use presumed consentSpain has consistently had the world's best donation rate, about 32-35 pmp, for more than 10 years,...

Factors influencing consent rates of deceased organ donation in Western Cape Province, South Africa

“…The Spanish system, currently the highest-performing in the world, noted an increase in deceased donation only after the formation of a national co-ordinating body and other quality-assurance mechanisms 10 years after presumed consent legislation was enacted. [16,17] The family refusal rate was 16.4%, even with presumed consent. [2] In a large study assessing the potential donor pool in the USA, it was concluded that resources were best invested 'to improve the process…”

The Gift of Life

“…If, family consent rates could be improved from the current 57% to Spanish levels of 85%, the UK's donation rate could be one of the best in the world. (13) Lack of adequate infrastructure and resources in developing countries pose a major roadblock for the retrieval and matching of organs, even if consent was available. Huge governmental investment in retrieval hardware and logistics would be necessary.…”

A Case for an Opt-Out Organ Donation System in Canada

“…For example Fabre, professor of clinical sciences at King's College London, has been very vocal in his opinions, calling the 'opt-out' scheme "unnecessary and corrupting" [10]. This is an understandable position.…”

“…A common argument against 'opt-out' is the aspect of informed consent. Fabre is right in calling informed consent a corner stone of medical ethics [10]. However, informing the public can be achieved by having health care professionals explain the program during regularly scheduled appointments.…”