Tuesday, 2 July 2013

‘Presumed consent’ for organ donation is both unnecessary and unethical

Wales could become the only UK country with an opt-out organ donation system if politicians vote to change the law today.

Currently an ‘opt-in’ consent system operates across the UK.

Individuals can authorise organ removal from their bodies after death by joining the Organ Donor Register (ODR), or making their wishes known to their family.

However the Welsh government wants to introduce new legislation which would authorise doctors to remove organs and tissue from any patient declared dead, unless the deceased had formally registered their objection.

I strongly support organ donation but so-called 'presumed consent' involves neither consent nor donation – it is neither voluntary nor informed and involves taking organs rather than giving them.

It means effectively that the state will be able to overrule families and there is a very real danger that it could also prove counterproductive and undermine trust leading to fewer rather than more donations. Introducing this legislation would be a radical new step, which is both unnecessary and unethical as a way of increasing organ donation rates.

The claim that donation rates could increase by up to 30% through presumed consent legislation is disingenuous as there is little evidence that this is any better than other schemes in other countries, and there are alternative ways of increasing donation rates.

Donation rates in countries with ‘presumed consent’ laws do not actually differ from countries requiring explicit (opt-in) consent. In fact, some countries operating presumed consent systems have lower rates of organ donation!

Differences in rates are due to other factors including the numbers of potential donors, provision of intensive care facilities, end of life care, use of transplant coordinators, trust in the donation system and trust in the medical profession (particularly those treating dying patients) (See here for a BMJ article on this).

Organ donation is a generous gift and should be encouraged. It resonates strongly with the Christian principles of sacrificial generosity and love for one’s neighbour. However, consent to organ donation should always be voluntary (un-coerced), informed and autonomous. 

As Patient Concern has warned: ‘Assurance that every citizen would hear of the new law, understand it, realise its implications, grasp how to opt-out and get around to doing so – if they wish – is pure fantasy.'

The groups least likely to express their views, if they hold views on this, will include those who are disabled, less well educated or informed, lacking full capacity, of different languages and race, suffering from mental illness, dependent, those who have less ready access to information and those changing their minds. Silence in many of these cases would and should not amount to consent to donation under an opt-out system.

Organ donation should be encouraged as a gift, but this system lays the framework for the taking of organs as a right. That is a very dangerous precedent indeed.

Although this specific legislation is only for Wales, there is increasing pressure to bring in similar legislation in England and Scotland. So it is not just an issue for Wales, it is one that the rest of the UK may well soon be considering.

This is why it is so important that the Welsh government rejects this measure today.

See past CMF submissions on presumed consent here, here and here


  1. I think you would change your mind in a hurry if you needed a kidney, lung, heart or corneal tissue, Peter.

    1. It's easy to indulge in the luxury of distance when you're not personally affected by a moral issue.

      For that matter, organ donation shouldn't even be optional. If the organs are viable, they should be used to save lives.

      And isn't it your side who always wants women to sacrifice their bodies for nine months to save lives?

    2. There is a big difference between giving ones organs and having them taken regardless of what you or your family might have wanted.

      I thought you believed in autonomy.

    3. When you're dead, you're dead. Those who are no longer living do not have autonomy any longer. Why should their "rights" or those of the family trump the rights of those who need organs to live?

      I thought you were in favour of life.

    4. Not at any cost Winston. There are moral rubicons that should not be crossed even it it means death.

      There are other more effective ways to increase the organ supply than this.

    5. But embryonic organ cloning several years away at best.

  2. Once I'm dead God gives me a new resurrection body. I don't understand why I should be at all bothered about this. I haven't opted to donate my organs simply because like many people I am lazy and apathetic. I want to live on this earth a very long time but I understand that God has the right to take me whenever He wants to.

    1. Sure. We don't need our bodies after death. But there is a dangerous precedent here - once the body becomes the property of the state and the family has no say there is much more that could happen in time in terms of near dead donors being harvested etc. Best to keep organ donation as just that - a donation.

    2. Read my piece on organ donation euthanasia in Belgium - http://bit.ly/15b7Vu1

  3. If Worshipper Tom and I (plus our families and Peter as our doctor) were the only ones on earth, I would whole-heartedly agree. Trouble is, that's not reality, and not everyone does agree. A foundational principle of jurisprudence is that society has a right to protect itself (perhaps even better, a DUTY to do so- under God's authority. In that context, can it be just or loving to disrespect other people's (lack of) knowledge, understanding and wishes by presuming consent when none is explicitly given?


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