Medical practice

Organ donation Q&A

The shortage of organs available for transplant would not be solved by introducing a new system of “presumed consent” of organ donation, a government appointed taskforce has concluded.

At present, people must “opt in” by specifically placing their names on the Organ Donor Register if they wish to donate organs after death.

The finding sparked widespread media coverage, not least because Gordon Brown, the prime minister, was said to support a move to “presumed consent”.

The report by the Organ Donation Taskforce concluded there were better ways of increasing organ donation rates but said it would revisit the issue of consent in five years time if these did not work.

Why is organ donation important?

Around 1,000 people died on the waiting list for an organ transplant in 2007-08. In the same period 3,000 people received a transplant.

The taskforce called this a “desperate situation” and said that people had “died in vain on the waiting list”. It aims to raise the number of registered organ donors from 15 million to 25 million over the next five years. Because of a shortage of organ donors in the UK, there are now more than 8,000 people on the transplant waiting list.

What is the current UK system?

At present, the UK has an opt-in system that means you have to register to be an organ donor. Doctors can only remove organs from people who have registered.

In addition, even if a person has volunteered, it is normal practice for doctors to inform their relatives at the time of their death. If family members oppose donation, a doctor may decide not to proceed.

Registration is with the NHS Organ Donor Register, run by UK Transplant.

What system did the taskforce consider?

The taskforce considered, and eventually rejected, a “soft” opt-out system for organ donation, similar to one used in Spain.

Under a “soft” opt-out system, doctors could remove organs from any adult who died unless they had registered their wish not to be a donor. Unlike a compulsory, “hard” system, relatives would still be asked for their agreement.

In addition, and contrary to what is mentioned in some news articles, the system would not technically be one of “presumed consent.” Doctors would not automatically presume consent in all situations.

Will the system change?

The taskforce recommended that an opt-out system should not be introduced in the immediate future and gave a number of reasons for this decision.

While the taskforce found the public overwhelmingly supported organ donation, it believed there was the possibility that people might be upset by a move to an opt-out system. Ultimately this could lead to a negative view of donation, rather than significantly increasing donation rates.

Also the taskforce identified opportunities to improve donation rates that did not involve changing to an opt-out system.

Spanish officials say that, despite their opt-out system, the most important factor in increasing donation was the organisation and co-ordination of their national transplant system.

What will happen instead?

The government has proposed a major campaign to help people understand organ donation and the issues around it.The report also recommends a range of changes to the existing system, including the recruitment of around 100 extra donor transplant co-ordinators.

These and existing co-ordinators would be employed centrally by NHS Blood and Transplant rather than by individual NHS trusts. This would standardise employment and training practices across the country, making the system more effective.

Other changes would include a strengthened network of dedicated organ retrieval teams, to be available 24 hours a day. The teams would work closely with the critical care teams in hospitals to retrieve safe high-quality organs for transplant.

The taskforce has recommended reviewing the issue of opt-out systems in 2013, once it is clear whether action to increase the number of donors has been effective.

How can I register as a donor?

You can register using the UK Transplant online form or calling on 0845 60 60 400.

NHS Attribution