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Opt-out scheme is still best way to increase organ donation, says BMA

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1098 (Published 14 February 2012) Cite this as: BMJ 2012;344:e1098
  1. Susan Mayor
  1. 1London

The BMA is calling for public discussion about new ways to boost the number of organs available for donation, including using organs from people who would currently be considered unsuitable and reversing a previous decision against an opt-out scheme.

A report published this week predicts that people will continue to die unnecessarily while waiting for a transplant even if the Organ Donation Taskforce meets its target of increasing the number of donors by 50% by 2013.

The BMA’s Medical Ethics Committee, which developed the report, recognises that the organ donation system has improved dramatically over the past 10 years, that new legislation has clarified previous uncertainties over consent and organ donation after circulatory death, and that a new legal system has been established for living organ donation. The government and devolved health administrations have also accepted and funded measures recommended by the Organ Donation Taskforce, set up by the UK government in 2006, to establish a more structured and systematic approach to organ donation.

The latest figures show a 25% rise in donation rates from deceased donors over the past few years. But the BMA considers that organ transplantation is still not reaching its full potential. At the end of March 2011 7800 people were on the UK waiting list for a transplant, with nearly 3000 more temporarily suspended from the list because they were considered unfit or otherwise unsuitable for a transplant.

“We are at a crossroads in terms of public policy,” said Tony Calland, chairman of the BMA committee. “As a society we need to decide whether we should accept that we have done all we can or whether we should move forward, cautiously, and look at other options for increasing the number of donors.”

The committee suggests that one way to increase donations is to use organs from “higher risk” donors, such as elderly people or people with a history of cancer or high risk sexual behaviour.

The report suggests that a balance would need to be reached between the risks and benefits of using such donors and that potential recipients would need to be made aware of these.

The committee also recommends measures to increase awareness of altruistic non-directed donation by living donors and asks for clarification on the use of elective ventilation in people who are brain stem dead, with the aim of allowing time for organs to be retrieved.

The BMA said that it is convinced that an opt-out system, where it is assumed that people want to donate their organs unless they have registered their desire not to, is most likely to make a difference to organ donation rates, despite the fact that the Organ Donation Taskforce recommended against an opt-out scheme.

There is evidence that countries with opt-out schemes tend to have higher donation rates, the report notes, although it is not clear if this is a causal association.

The BMA is recommending an opt-out system with safeguards in which the potential donor’s family is always consulted and asked about any unregistered objection and where donation can be stopped if this would cause severe distress to the family.

“The main practical change would be in the approach to relatives,” the report suggests. “Rather than asking them to make the decision . . . relatives would simply be asked if they were aware of any unregistered objection.”

The group considers that an opt-out approach would change the philosophy of donation, making it the usual and expected process when someone dies.

The Welsh government is planning to publish a draft bill this summer introducing an opt-out system for people living in Wales. The BMA committee said that it would be interesting to see how this progresses and what lessons it may hold for the rest of the UK.

Notes

Cite this as: BMJ 2012;344:e1098

Footnotes