The issue of organ donation has remerged in the media again over that last couple of weeks, as the Welsh Government’s consultation on Presumed Consent legislation has come to an end.
Under the Welsh Government's proposals, everyone in Wales will be put on the organ donation register, allowing their organs to be freely available for donation when they die, unless they have opted out. The Government hope to introduce a Bill this year, with the intention of getting it passed sometime in 2013, paving the way for what would be the first system of its kind in the UK. The new system would then start in 2015 after allowing time for a public information campaign.
With more than 400 Welsh patients currently on the transplant waiting list, this is an important issue that must be addressed. Organ donation is proven to save lives and I welcome initiatives to raise awareness of the need to increase the pool of potential donors.
However, I have very serious concerns about the introduction of an opt-out organ donation system.
The British Medical Journal concluded last year that ‘soft’ presumed consent may not be the best way to increase organ donation rates. As with the current system, consent would still lie in the hands of family members who would retain the right to veto donation, regardless of whether the individual had not opted in or out.
In addition, the UK Government has raised concerns that an opt-out organ donation system may not be compatible with the Human Rights Act and my Welsh Conservative colleagues and I are concerned about the impact that diverging legal systems in the UK could have in this area.
I am yet to be convinced that legislation is required to increase organ donation rates. Those who do support a legislative change often point to the Belgian model as an example of what Wales should follow. Yet, even in Belgium presumed consent has not meant that people no long wait on transplant lists; it has not meant that people no longer die waiting for a transplant; nor has it meant that there is a surplus of organs. These things still happen.
I think the Spanish model is the one that should be looked at in more detail as it has the highest rate of organ donation in the world. While it did pass legislation on donation back in 1979, it has never been used; it has lain dormant for over 30 years. It does not have a donor register as we do in the UK nor does it have a government who actively promotes organ donation cards – only about 8% of the Spanish population have a donor card compared to nearly 30% in the UK. The secret to Spain’s success is that it does have a positive social attitude towards organ donation but more than that they have an extremely organised organ donation organisation – Organizatión Nacional de Transplantes.
For example, the Organization increased the countries provision of intensive care beds and doctors who can deal with a large amount of acute patients with poor prognosis - the most likely place where potential donors will be found. They also installed transplant co-ordinators at each procurement hospital so that each stage of the process can be navigated as quickly as possible – that includes the most important aspect which is approaching the potential donor’s family. The key component of this model is training and trust. Since 1991, regular courses on the entire process and on particular aspects of deceased donation have been targeted at all professionals directly or indirectly involved in organ donation. So in Spain, over 11,000 clinicians and medical professionals have trained on these courses. In relation to trust, medical professionals have built up a level of trust and understanding over many years delicately dealing with individual circumstances and the wishes of a potential donor’s family, which has enabled the population at large to have confidence in the system.
I firmly believe that if the Welsh Government focused on underpinning our donation system with a strong organisational model, coupled with more trust and awareness raising programmes, we would see an increase in organ donations without the need of legislation.