Removing the barriers to consent for organ donation

Within 24 hours of these words appearing in print, Team GB is likely to have won at least three more medals, and during the same time frame at least three

more British people will probably die waiting for an organ transplant.

Each year about 1000 patients lose their fight for life, a life that could have been saved by an altruistic gift from someone they probably had never met.

This has led to widespread calls for the replacement of the current opt-in system for organ donation by what is known as a soft opt-out system, where a

person's consent is assumed unless they have objected in their lifetime. Wales is consulting on such a scheme, which has improved the level of donated organs

in Belgium and Spain. Recently our sister paper, the Evening Times, has done much to raise the profile of the opt-out campaign through a well-supported

petition and by sharing stories of the suffering of those waiting for transplants and the joy of those who have had one.

How far would an opt-out mechanism go towards eliminating the growing transplant organ shortage? Much depends on the attitude adopted towards the views of

the bereaved family and relatives.

As The Herald reports today, such a move may make less difference than anticipated if relatives continue to have a veto. Currently, around a quarter of

suitable organs are never transplanted because of the refusal of the bereaved. Even when the dead patient is on the donor register, one in 10 families

withholds consent. They may assert that the patient "has suffered enough" or worry that staff will not strive to save a person's life if there are plans in

place for transplanting their organs. Often the issue has never come up in conversation.

The gap between demand and supply of organs could be diminished if relatives were not allowed to over-rule the wishes of the deceased, argues Dr David Shaw

of Aberdeen University. He describes respecting the veto as "unethical, unprofessional and against the spirit of the law".

This is an ethically complex area. It touches on the relationship between the citizen and the state and that between patient and doctor. It pitches the

rights of suffering patients against those of grieving relatives. The Herald has argued that any change to the system must take the public with it, or risk

making the organ shortage worse instead of better, as happened in Brazil.

Under the proposed Welsh scheme, clinical teams will have a duty of care towards the bereaved and must take into account strong objections, especially when

the views of the dead person are unknown. The scheme proposed by the BMA and supported by Kidney Research UK leaves the final decision with loved ones.

Surely the answer lies not in surgeons removing organs in the face of objections from the grieving spouse and offspring, but all of us openly discussing our

wishes with our nearest and dearest. The biggest barrier to improving the level of consent for organ donation is not the obstruction of irrational relatives

but ignorance.