Organ donation- how can we increase numbers without compromising our ethics?

Andre is CMF's junior researcher in Public Policy and Advocacy.
The views expressed do not necessarily reflect those of CMF.

We are facing an organ donation crisis. The need for organ transplants is currently outstripping the supply of donated organs. This can be seen plainly from the statistics, where, in the period 2015/16, 4,605 total organ transplants were undertaken in the UK, but 6,463 were still on the active waiting list by the end of the year.

Seeking out ways to try and plug this gap is one of the reasons for the recent Scottish Government consultation on introducing ‘presumed consent. You can read our response here.

This is a shocking shortfall that leaves people, in the case of kidney transplants, waiting an average of 944 days for a lifesaving operation. Something clearly needs to change. But how can we meet this need, without making ethical compromises which can prove detrimental to the whole enterprise?

A lot of hype has been generated in the media (eg. here and here) around attempts to change the system of donation from being one of opt-in (where everyone expresses their consent to be a part of the Organ Donation Register (ODR)) to one of opt-out, (where  consent to organ removal is presumed, unless stated otherwise).

While I don’t seek to re-tread ground that has been covered by other blog  posts too much (here, here, here, here, here, here and here), it is important to wait and properly analyse the effects of the change in Wales and the historic effects on Spain (here, points 185-192), before seeking to change the law in Scotland, or in other parts of the UK.

We have very little data at the moment from which to analyse the success or not of the Welsh experiment, despite media attempts to spin its statistics to try and proclaim it as a brilliant success. The statistics in 2015/16 suggest no real change compared to long term trends, with 214 total organ donations, compared to 210 in 2012/13 (though it was only introduced on 1 December 2015), while the first three quarters from 2016/17 suggest a slight decrease. However, we will need to wait before we can try and deduce any long term changes.

It is also important to note the weakness of opt-out systems when it comes to ensuring that all-such ‘consent’ is fully informed, not just immediately, but also for the entire lifecycle of the policy. This can also be seen in the projected cost to make this happen (see p31), though even this may not affect everyone.

Without a sense of informed consent, the perception can become, in the words of Professor Segev in the US: ‘We will take your organs unless you take the time to fill out a form’. This can jeopardise the trust patients and families have in their doctor. This has repercussions on wider reputation for the donation system (see the Alder Hey Scandal, for the impact of negative perceptions about organ donation). This highlights the need for specialist nurses to facilitate these conversations.

This is before getting to the effectiveness of opt-out vs opt-in systems, which are looked at extensively here, here, here (points 185-192) and in our recent submission to the Scottish Consultation.

There are more ethical considerations around the practice of organ donation generally, about which we also need to be aware. There needs to be differentiation between the organs that are taken and their uses. The Anscombe Centre rightly sees a difference between normal and generative tissue, where issues of identity (p.35-36) and complicity in embryo research and abortion (p.32-33) are genuine concerns.

There are also questions about the definition of death and its implications within organ donation (see here) and whether brain stem death is a sufficient condition for the taking of organs (as cadavers may not be used if the circulation system is still functioning).

I fully support the practice of organ donation, as do we at CMF, but we want to ensure that it is being conducted in the right manner. We can see here the joy that can be found in giving and receiving organs. We need to love our neighbour like we love ourselves (Leviticus 19:18), and the example of Jesus to ‘lay down his live for his friends’ (John 15:13) shows the extent of sacrificial love that we should aspire to have for others. We just need to be aware not to compromise our ethics in the search for ways of improving the lives of thousands of people.

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