Letters

Presumed consent

If this is introduced, people will have to have all relevant information

We know that our daughter lives on

If this is introduced, people will have to have all relevant information

EDITORBeecham reports that the BMA wants to start a debate on presumed consent to organ donation.¹ Ethically, consent should be informed, whether it is expressed or presumed. Presumed consent to organ donation takes for granted that everyone who has not registered an objection consents to their organs being taken for the benefit of others when they are brain stem dead and that they understand what this state is. It is not, however, death as ordinarily understood. Nor is it "brain death" as defined in various parts of the world. Its status is controversial, not least because claims that, for example, it invariably leads to death within a few hours or days are no longer tenable.²

Under our present system, willingness to donate organs is a positive offer. People who carry donor cards, and those on the NHS Organ Donor Register, have agreed to the removal of various organs "after my death" (the wording on the card) and may have no idea of the condition they will be in if the offer is taken up. They may never have given the matter serious consideration.

People would probably have the greatest difficulty in obtaining the information that artificial ventilation and spontaneous heart beat and circulation will continue after they are pronounced brain stem dead while some brain and even brain stem activity persists. It remains a common misconception that all life support is withdrawn before surgery or organ harvesting begins. Further, it is not generally known that some anaesthetists give full anaesthesia for organ harvesting while others paralyse the patient but withhold anaesthesia.

If consent is to be presumed there is a prior obligation to provide the population with all relevant information in readily accessible form. Failure to do so might risk charges of deception by silence and omission. Public suspicion of transplant practices seems to have been behind the recent repeal of a presumed consent law in Brazil.³

If a system of presumed consent is to be introduced it must ensure that those whose silence is taken to presume consent are fully aware of all the relevant facts.

David J Hill, Anaesthetist. 
The Old Post Office, Eltisley, Cambridgeshire PE19 4TG

Tony C Palmer, Veterinary neuropathologist. 
12 Adams Road, Cambridge CB3 9AD

David W Evans, Retired physician. 
27 Gough Way, Cambridge CB3 9LN dwevans{at}dcoe.globalnet.co.uk

We know that our daughter lives on

EDITORThe news that the BMA wants to start a debate that could bring in legislation to presume consent is extremely heartening.¹ As parents of a 22 year old girl who died in a road accident last September we feel very strongly about this. Our lovely daughter Zoë was very keen that her body should be used to help other people enjoy their lives if she should die.

Zoë was extremely fit and healthy all her life, but, with the present inadequate system of having to obtain relatives' consent, two hours had elapsed before the police and hospital were in touch with us. We said to the hospital, "Use whatever spare parts you canthat is what Zoë wanted." But by that time it was only possible to retrieve her corneas and heart valves.

With so many people dying while waiting for transplants, we feel that not to use Zoë's young and healthy body for the benefit of lots of other people was a criminal waste. Nothing could bring Zoë back, and our grief in losing her is beyond expression. But surely every one of us, not only doctors, has a moral duty to do everything we can to give the living the best possible quality of life.

Organ donation costs us nothing but is a gift beyond price to those who need transplants. Knowing that through her death Zoë has been able to help restore sight to a 24 year old man and improve the quality of life of two children who were given her heart valves makes us very proud; we feel that a little of our wonderful, loving, caring daughter lives on with them.

We will watch the unfolding of the presumed consent debate with interest. In the light of our own experience, we are passionately in favour.

Sue Cansdale, Mother. 
Richard Cansdale, Father. 
The Baker's Chest, Hartburn, Morpeth NE61 4JB