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that they have no legal right to veto or overrule them. In some cases, however, there still may be circumstances

where donation may not be appropriate.

If there is no record of the deceaseds wishes, the medical staff will approach the relatives or other relevant

people to establish any known wishes of the deceased. If these are not known, and the deceased has nominated aperson to deal with the use of their body after death, then consent can be given by that person.

If neither of the above apply, consent to donate can be given by someone in a "qualifying relationship"

immediately before the death of the deceased person. Those in qualifying relationships differ slightly for

Scotland but both lists, which are set out in a strict order of priority, include family members and close friends.

Alternative consent systems

As well as the opt out system which is in current practice in a number of countries around the world, anothersystem known as required request is also used.

Opting out / presumed consent

Under a system of "opting out" or "presumed consent", every person living in that country is deemed to havegiven their consent to organ donation unless they have specifically "opted out" by recording in writing their

unwillingness to give organs.

Supporters of such a systems introduction in the UK believe that establishing an automatic right to take organs

when the donor has not expressed wishes to the contrary would lead to a significant increase in the number of

potential donors. They also conclude that the relatives or those close to a person who has not expressed a wish to

donate would be relieved of the burden of making that decision at such a traumatic time.

One fear with presumed consent is that people wont get round to registering an objection and the subsequent

expectation that organ donation should take place could lead to unnecessary distress to their relatives and

widespread adverse publicity.

Many transplant recipients add that a donated organ is more easily accepted because they know it has beenpositively given by the deceased whereas presuming consent would turn donation into an action by default.

Other concerns surround the potential medical risks involved in removing organs without full discussion with

relatives. Families are a valuable source of information about their loved one's previous health and relatives are

questioned as part of the screening process.

If an individual does not register an objection, it is possible that their silence may indicate a lack of

understanding rather than agreement with the policy. It is because of these concerns that in the majority of

countries operating an opt-out system, health care professionals still consult the family to establish consent.

Required request

A policy of "required request" or required referral is operated in the United States of America. Required

referral is defined "that it shall be illegal, as well as irresponsible and immoral to disconnect a ventilator from an

individual who is declared dead following brain stem testing without first making proper enquiry as to the

possibility of that individual's tissues and organs being used for the purposes of transplantation".

The policy means opportunities for donation are less likely to be overlooked. Many individuals may be havingtheir right to donate removed if their relatives are not approached. The next of kin also has a moral and legal

right to know they can donate organs and tissue if they or the family so wish. Many families report that such a

donation was helpful rather than harmful.

Although the introduction of this scheme saw an initial increase in the availability of organs, over time the

numbers have declined.


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Experience in other countries

Large disparities in organ donation rates exist throughout the world, despite the laws governing organ donation.

Some European countries with opt-out systems have higher donation rates than the UK. However there is no

clear evidence that opt-out is the sole factor. The fact that Sweden has an opt-out law does not seem to influence

the donation rate per million of population, which is lower than that of the UK, which does not. Within almost allcountries, large local variations exist in donation rates, despite a common legislative background.

Opt-out systems can be "hard", as in Austria, where the views of close relatives are not taken into account, or

"soft", as in Spain, where relatives' views are sought.

Different cultural attitudes to the disposal of bodies, greater provision of intensive care beds, more pro-active

donation programmes and the numbers of road deaths, each play their part. However, the single most importantfactor so far identified is ensuring that the relatives of potential organ donors are always approached, and

approached by someone specifically trained for the purpose, as happens in Spain.

In fact, while Spain is recognised as having a higher number of donors than the UK, it is acknowledged by the

director of national transplant organisation in Spain himself that the increase in organ donation during the 1990scould not be attributed to a change in legislation which had remained the same since 1979. The improvements in

donor rates in Spain followed the implementation of a comprehensive national procurement system.

NHSBT's position

We welcome any debate that raises the value and importance of transplantation and increases the general

publics knowledge of the importance of organ and tissue donation.

Transplant services in the UK are renowned for the honest, open and transparent manner in which they operate.

This is due, in part, to the fact that consent has always been an integral part of the process of donating organs for

transplant. In turn, society, recipients and their families acknowledge the wonderful gift of life that donors

contribute. During 2006-07 the generosity of donors led to a 10% increase in the number of solid organtransplants to an all-time high of 3,087. Since 2002, around a million people have joined the NHS Organ Donor

Register (ODR) every year, pledging to pass on the gift of life.

Our current experience in the UK shows that up to 90% of people support organ donation with more than 15

million people, or 25%, having joined the ODR. An ongoing potential donor audit of deaths in intensive care

units shows that six out of ten families approached about organ donation will give their agreement or

authorisation for donation. It makes it easier for them if they know the donor has registered their wish to donateon the ODR.

The Human Tissue Acts introduced in 2006 reinforce the importance of giving consent for donation. Many

people have found it difficult to accept that relatives could overturn any wish they may have registered orexpressed during their lifetime but the new law makes it explicit that it is the wishes of the deceased individual

that should prevail. .

The important issue is that people discuss their desire to donate organs so that close family members and friends

are aware of their wishes. As much as possible should be done to persuade people to join the NHS Organ DonorRegister by calling 0300 123 23 23 or viawww.organdonation.nhs.uk

NHSBT is neither against nor in favour of a change to presumed consent legislation. Now that the Organ

Donation Taskforce review has been delivered, we will continue to promote the need for more voluntary

registrations on the Organ Donor Register. We will work within whatever legislative framework is introduced in

any of the four health administrations in the United Kingdom. In the meantime, we work in earnest towards

supporting the implementation of the 14 recommendations contained in the Taskforces first report which are

seen as critical prerequisites for improving organ donation in the UK.
http://www.organdonation.nhs.uk/http://www.organdonation.nhs.uk/http://www.organdonation.nhs.uk/http://www.organdonation.nhs.uk/

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