Intended for healthcare professionals

Editor's Choice Editor's choice

Presumed consent

BMJ 2007; 335 doi: (Published 26 July 2007) Cite this as: BMJ 2007;335:0
  1. Fiona Godlee, editor, BMJ
  1. fgodlee{at}

    In his report on the nation's health (BMJ 2007;335:113 doi: 10.1136/bmj.39280.523657.4E), England's chief medical officer Liam Donaldson calls for presumed consent for organ donation. The BMA has long campaigned for such a system, and to this we can add the weight of the BMJ and its readers. Independence from the BMA (last week's editor's choice doi: 10.1136/bmj.39280.634977.47) means we sometimes usefully concur. Our head to head on 26 May asked whether presumed consent was the answer to organ shortages (BMJ 2007;334:1088 doi: 10.1136/bmj.39199.475301.AD; BMJ 2007;334:1089 doi: 10.1136/bmj.39199.475301.AD). While the arguments against were interesting, those in favour were convincing, and most readers who responded to our poll (although our smallest turnout yet) were in favour.

    As I write, someone I know is preparing to donate a kidney to a friend. What's astounding about this is not only her generosity and courage but the fact that this should be necessary. So what's holding up a change in UK law? There's good evidence that opt-out systems in other countries have improved organ supplies (Science 2003;302:1338-9, Lancet 1998;351:1650-2), but patient groups cite remaining concerns, including the possibility that organs might be taken against a family's wishes. Effective information campaigns—explaining how such a system would actually work—will be essential in bringing about this long overdue legislation.

    In the foreword to his report, Donaldson says his role requires him to tackle today's heath challenges “without fear or favour.” This sets him in stark contrast to his departing US counterpart, Richard Carmona (again, last week's editor's choice doi: 10.1136/bmj.39280.634977.47). Donaldson's record on championing public health has been impressive. Less so his record on medical staffing, for which he apologises in the report, but which few who've been caught up in the ongoing debacle of specialist training posts will easily forgive.

    Here's a poll we won't be running, although perhaps you'll think we should. Is the current sense of fragmentation and disempowerment within the UK medical profession down to cock-up or conspiracy? If it's a conspiracy, it will have needed planning and coordination across government departments over a sustained period that is hard to imagine. On the other hand, cock-up suggests incompetence on an extraordinary scale. Iona Heath comes down on the side of conspiracy, referring to “the apparently deliberate creation of unemployment among junior doctors, and a campaign of insidious vilification of doctors” (p 183 doi: 10.1136/bmj.39286.704722.59). She argues passionately for a healthcare system based on social solidarity rather than profit, and one that values highly trained clinical expertise.

    Michael Goodyear agrees. Quoted in the review of Wendy Savage's book (p 209 doi: 10.1136/bmj.39283.676910.4E) he writes, “Cultures of excellence not only value their workforce but let them know they are valued.” Neville Goodman, retiring from clinical practice and as a columnist for Career Focus, concludes “I know that I taught well, and that is enough” (see Career Focus 28 July on But the NHS's failure to provide professional and financial reward has meant the loss of John Petri, who tells us why, despite being applauded for innovation in surgery, he is leaving for Switzerland (p 210 doi: 10.1136/bmj.39282.619641.4E).