Doctors should defend the wishes of patients on the organ donor register more “robustly”

BMJ 2013; 346 doi: (Published 12 April 2013) Cite this as: BMJ 2013;346:f2357
  1. Zosia Kmietowicz
  1. 1BMJ

Doctors and transplant coordinators need to more forcefully represent the views of people who have joined the organ donor register when families refuse to allow their organs to be harvested, those working in transplantation have said.

Although there has been widespread applause for the efforts made in the United Kingdom over the past five years to increase the number of deceased organ donors and transplantations, experts have said that a “revolution” is needed in public consent for organ donation if the rates are to improve further.

Figures released by NHS Blood and Transplant show that the number of deceased organ donors in the UK increased by 50% in five years, from 809 in 2008-09 to 1212 in 2012-13. However, Sally Johnson, director of organ donation and transplantation at the organisation, said that the rate at which families refuse to allow the organs of their deceased relative to be harvested has remained stagnant at around 42%.

Fewer than 5000 of the 500 000 people who die each year in the UK every year are suitable for organ donation, and rates of consent need to increase to help the 7300 people currently waiting for an organ transplant.“We need a revolution in consent if we are ever going to match world class performance in terms of rates of transplantations,” Johnson told the BMJ.

Figures for 2011-12 have shown that 125 families overruled their relative’s wish for their organs to be used for transplantation after their death.

Elisabeth Buggins, who chaired the Organ Donation Taskforce to advise the government on boosting transplantations in 2008,1 said that doctors needed to be more “robust” in arguing the case of the people who had signed the organ donor register. “The Human Tissue Act says that if someone’s name is on the organ donor register, then in law that has the same force as informed consent in a person’s lifetime—just the same as a will,” she said. “It is a difficult line to tread and we have to tread it sensitively, but a lot of this is in clinicians’ hands.”

Work from focus groups had shown that people did not want their family to override their decision to donate organs, she added.

In 2008, the government funded a campaign to increase the number of people on the organ donor register from 15 million to 25 million by 2013, following recommendations made by the taskforce.2 Currently, 19.5 million people are on the register.

Registration is highest in Scotland, where 41% of people (2.15 million) have signed up to donating their organs, up from 29% (1.5 million) in 2008. The success is largely because of a sustained advertising campaign in Scotland, which has not run in England because of a ban by the Cabinet Office.

Last year, the BMA published a report on the options to increase organ donation, which concluded that the UK should adopt a “soft opt-out system” where unless an individual had registered an objection to donating their organs, or their family was aware of any objection, the default position would be to donate.3

Sue Robertson, a member of the BMA’s Scottish Council and a renal physician, said: “As long as there are patients waiting for transplants, the BMA believes that a soft opt-out system, as part of the overall package to increase donation, would save more lives. Now is the time for a serious debate about moving to opt-out.”


Cite this as: BMJ 2013;346:f2357