Views & Reviews From the Frontline

It’s better to give

BMJ 2009; 339 doi: (Published 04 November 2009) Cite this as: BMJ 2009;339:b4546
  1. Des Spence, general practitioner, Glasgow
  1. destwo{at}

    As a child, a day meanders; as a teenager, the weeks roll; in your 20s the months tumble; and after you have children the years whizz by—I recall not a day of my 30s. We greedily squander time, taking it for granted. Until the “it’ll never happen to me” inevitably does. Then time is the only valued possession: anything for a few moments more with our loved ones. I once carried an organ donor card, but it perished in the part of my wallet full of video shop cards and business cards from pushy colleagues I had taken only out of politeness.

    The UK has a chronic lack of transplant organs, and attempts are being made to increase donation. But currently only 60% of relatives agree to requests to donate if the patient is not on the organ donation register. Proposals for presumed consent schemes have faltered, amid resistance and a fear of undermining the doctor-patient relationship. So, recently the General Medical Council floated a new idea: general practitioners would be required to ask all dying patients about organ donation.

    But as the idea drifts by, the guns are coming out. Most patients dying at home have metastatic cancer or are very elderly; neither group are straightforward organ donation candidates. Also, many patients specifically choose to die at home to avoid excessive medical intervention—and this runs counter to transplantation. Anyway, how will organs be salvaged in the community setting? Finally, general practitioners struggle even to discuss where people want to die, so asking, “Oh, and can we have your liver?” seems a non-starter.

    But there seems an obvious solution. Why don’t practices encourage patients to enrol on the organ donor register online? Registering takes only about a minute, and we could place a computer in the waiting room. At any time of year there will be someone there, but more so in these darkest of months. Furthermore, why not incentivise this activity through the quality and outcomes framework (QOF), creating one useful outcome in a thousand stupid ones? Then, if one day our life support machine has to be turned off, many more of us can offer a stranger that rarest of gifts: time.


    Cite this as: BMJ 2009;339:b4546

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