Everyone 'should donate organs'

Everyone should be seen as a potential organ donor on their death unless they expressly request not to be, England's chief medical officer says. Sir Liam Donaldson calls for a system of "presumed consent" to be introduced to tackle chronic shortages of organs.

One person dies each day after failing to find a suitable donor, Department of Health figures suggest. But scrapping a system under which people must clearly state their wish to be a donor will prove controversial. Such a move was rejected by MPs when they voted on the Human Tissues Act in 2004.

Both the then Health Secretary John Reid and Health Minister Rosie Winterton declared it was not up to Parliament to make decisions about what became of people's bodies when they died. But Sir Liam said that efforts to persuade more people to either carry donor cards or sign up to the NHS Organ Donor Register had failed.

Only 20% of the population - or 13 million - are on the register, despite the fact that surveys showed that as many as 70% of people wanted to donate their organs after death. Because so many people die in manner which makes them unsuitable donors, the pool of potential donors must be substantially larger than the numbers waiting for organs - currently nearly 8,400.

Sir Liam added that the gap between the number of people coming onto the waiting list and those coming off after receiving successful transplants was widening all the time. Both these factors, he hoped, meant "MPs may change their minds".

Transplant campaigners have welcomed the recommendations, although one health lobby group - Patient Concern - declared organ donation "was a generous gift, not an obligation". "Surveys may show a large majority willing to donate organs while less than 1 in 4 actually sign up. But giving the 'feelgood' answer in the street is very different from facing the reality of the process," said the group's co-director, Joyce Robins.

But the British Medical Association said it fully supported an opt-out system. "We must increase the number of donors available and the BMA believes that a system of presumed consent with safeguards, will help to achieve this," said Dr Tony Calland, chairman of the medical ethics committee.

Sir Liam said he was making the recommendation based in part on the experience of Spain. Donation rates have almost doubled there to 35 people per 1m since a system of presumed consent was introduced in 1990.

Opt-out countries include:

Spain

Austria

Belgium

Sweden

Denmark

Finland

France

Italy

Norway

Singapore

Spain runs a so-called "soft" opt-out system, where even if the person has not themselves opted out of donation while alive, the views of relatives are sought and they can refuse consent. Other countries, such as Austria, run a very strict system where the views of relatives are not taken into account at all. After Vienna passed the presumed consent law in 1982, the donation rate quadrupled and by 1990 the number of kidney transplants performed was nearly equal to those on the waiting list.

However, Sweden - which also has an opt-out law - has a lower donation rate than the UK, suggesting that other issues may be at play. It has been suggested that one of the reasons Spain's donation rate is so good is a result of the higher numbers of healthy people killed in road accidents. Therefore even if the UK did choose an opt-out system, critics argue, its donation rates still might not rival those of Spain.

Sir Liam said that any system introduced in the UK would need "proper safeguards" and would likely take into account the wishes of close family. He added that any new opt-out scheme would have to follow an intense public information campaign, and in any event, remained in the hands of parliament.