Organ donation is the act of giving an organ to someone who is in need of a transplant.
People can donate certain organs while they are alive, such as a kidney, but most organ donations come from people who have died.
The demand for organs is significantly larger than the supply, which means there is a waiting list for organ transplants. There are currently around 7,000 people on the UK Transplant Waiting List. In 2020/21, over 470 patients died before they could receive a transplant.
Only a small proportion of deaths (e.g. death from stroke or brain injury) allow for organ donation, because many types of death (e.g. circulatory death in which the organs are starved of blood) do not leave viable organs for use. With improved road safety and vehicle manufacturing, fewer deaths are resulting from brain death nowadays, meaning there is a growing shortage of organs for donation. Demand also exceeds supply because matches need to be as close as possible to ensure a successful transplant.
An additional challenge is that the BAME community typically experience longer waiting times for organ transplant, because there is a lack of suitable organs from BAME donors. In 2020, when approached about organ donation in hospital, 39.5% of BAME families agreed to support donation going ahead, compared to 69% of white families. Many of the BAME families had not discussed organ donation with their relatives and/or had concerns about whether organ donation aligned with their religious beliefs.
With an opt-in system, doctors can only use a person’s organs after death if that person signed up to an organ donation register during their life.
One of the biggest problems with an opt-in system is that many potential donors either don’t register or are unaware that they have the option to register. When England had an opt-in system (pre-2020), research showed that 80% of people supported organ donation in principle but only 38% had opted in, so the support didn’t translate into a high number of potential donors.
Those in favour of an opt-in system argue that this type of consent (informed consent) is the most valid and ethical, because people have explicitly agreed to donating their organs and nothing is being assumed.
With an opt-out system, if a person has not registered a decision to either become an organ donor (opted in) or not become an organ donor (opted out), they are considered to have no objection to being an organ donor after death. This is known as deemed/presumed consent.
In recent years, an opt-out system has been adopted by England, Wales and Scotland. The aim is to increase the number of people on the NHS Organ Donor Register, because it is expected that only people with strong views against organ donation will opt out. There are hopes that the opt-out system will lead to more lives being saved every year.
Those who oppose an opt-out system argue that deemed/presumed consent is less valid, because people could be unaware that they are automatically signed up to donate their organs.
In December 2015, Wales became the first UK nation to move to a soft opt-out system of consent for organ donation. The system is ‘soft’ because the families of potential donors have the right to a final say.
Figures from NHS Blood and Transplant show that Wales now has the highest consent rate of all UK nations – currently at 77% compared to 58% in 2015, when the new system was launched.
In spring 2020, England also adopted a soft opt-out system, in which people over the age of 18 are automatically added to the Organ Donor Register and must actively withdraw if they want to opt out of it. Families are still consulted before any organ donation goes ahead.
Arguments exist for both opt-in and opt-out systems. Get to know the ins and outs of the two different systems in preparation for your interview.
Looking at data from the UK, Wales has been leading the way with its organ donation consent rate compared to other UK nations since it adopted a soft opt-out system in 2015.
However, it can be argued that there isn’t conclusive evidence, on a global scale, that an opt-out system is ultimately more effective than an opt-in system. Although many European countries are covered by a body called Eurotransplant, there is significant variance in organ donation across different countries. Spain, which has a soft opt-out system, has the world’s highest organ donation rate, whereas other opt-out countries such as Luxembourg and Bulgaria have very low rates.
Hard opt-out systems around the world have seen increases of 25% in the donor rate, but it can cause controversy that this type of system disregards the opinions of surviving family members. Alternatively, Israel has an opt-in system which gives priority to patients on the donor register if they ever require a transplant themselves, providing an incentive to opt in.
Some argue that increasing the number of organ donors has less to do with the type of system adopted and more to do with how the system is managed. The recently introduced opt-out system in England, Wales and Scotland will need to be supported by ongoing communication with the public to raise awareness. Investment in education and training will also be required to ensure success.
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