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Transplant organs

BMJ 2000; 320 doi: (Published 17 June 2000) Cite this as: BMJ 2000;320:1678
  1. Douglas Carnall (dcarnall{at}
  1. BMJ

    This week a news story highlights a BMA campaign to increase the number of donor organs available for transplantation. In Britain the situation is worsening: 1000 patients each year die on waiting lists, which are increasing by 3% each year while the number of donor organs remains constant. At its annual representative meeting last year, the BMA advocated that donation of cadaveric organ transplantation should be on the basis of opting out (a register of non-donors) rather than of opting in (carrying a donor card), and its medical ethics committee has been carrying the new policy through. Its report is available on the BMA's website (

    Other countries that have adopted the opt out approach, such as Belgium and Spain, have managed to increase the number of organs donated, although they also revamped other related systems too. Civil libertarians demur, but opt out systems are driven by the basic fact that, although 70% of UK people claim to wish to be organ donors if eligible, only 20% fill out donor cards.

    This might be regarded as an informational problem. Making and storing an advance directive about one's wishes for organ transplantation on an internet server that could be checked by intensivists is technically straightforward; the difficult issues are social: quality, security, and confidentiality. Naturally, the United States is making some progress towards this goal on the web: you can read a weekly updated list of the number of Americans on transplant waiting lists, as well as drilling down for more detailed information about waiting lists in transplantation centres in a given locality.

    Promoting the idea of organ transplantation is more straightforward. The Coalition on Organ Donation is using “viral marketing” to get people talking about their wishes for organ donation. Viral marketing exploits the willingness of email users to forward each other files and links to things they have themselves enjoyed. Whether the BMJ's readers would enjoy downloading the excessively schmaltzy 600 kb presentation at is open to question, but internet marketeers are certainly abuzz about the technique.

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