Welcome to our new series on NHS Hot Topics 2017! These blogs will cover one recent piece of medical news from this year in detail.
The discussion around organ donation is not a new one, but is certainly topical and could potentially be the theme of a medical school interview question or group-based discussion. It is therefore important that you understand what organ donation is, how it relates to healthcare, and what has been said about it in the news.
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Organ donation is defined as the removal of an organ from a body, with the purpose of transplanting into another person who has medical need for it.
This definition includes “living donation”, in other words, the donation of a non-essential organ from one living person to another; however, the term “organ donation” is most commonly used to refer to the donation of organs from a patient who has died.
In England, Scotland and Northern Ireland, organs can only be donated if the person themselves has actively given consent during their lifetime, or if the family give consent after the person has passed away. Family consent is only valid if the person had given no indication in their lifetime that they would not want to donate their organs. This system is called an “opt-in” system.
In Wales, however, there has been a recent change in legislation meaning that people living there are automatically presumed to consent to organ donation, unless they explicitly withdraw their consent. This type of system called an “opt-out” system.
In the UK, there is a large difference between the number of organs available and the number of patients in need of them. This is because not only are a large proportion of the population not on the register (the figure currently stands at 36% in England and 64% in Wales), but most deaths result in organs that are not viable for transplantation. Although the number of people opting-in is generally increasing, many patients are still dying whilst awaiting a transplant; last year, the number of deaths amounted to 500.
Last month, UK Prime Minister Theresa May pledged to introduce the opt-out system in England. However, this has been met with some controversy.
Clearly, doctors want the best outcomes for patients who are on the organ waiting list. If this was the sole consideration, then transplanting organs from all patient who die, regardless of consent, would solve the problem. However, donated organs also come from patients, to whom doctors also have a duty of care. Taking organs without establishing consent certainly cannot be ethically justified. Thus, the issue of consent lies at the heart of the matter.
Those who disagree with the opt-out system argue that implied consent is invalid, as people will not be aware that they are automatically signed up to donate their organs. Furthermore, they may feel pressurised into not opting-out and therefore this consent is coerced, once again invalidating it. An opt-in system ensures that people are fully aware of what choices they are making.
Others who argue against the opt-in system, state that the majority of people who have not opted-in are willing to donate but have simply not gotten around to joining the register. This point of view considers that “forgetting to join the register” is simply not a good enough justification for the deaths that occur as a result, and that an opt-out system would solve this problem.
The issue of organ donation is a difficult one with no easy solutions. Keep up to date with any news updates regarding the introduction of an opt-out system in England, and consider the following questions when preparing for your interviews:
Words: Mariam Al-Attar
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