Doctors want 'Opt-Out' system for organ donors

Health: By Judith Duffy, Health Correspondent

November 27, 2005

DOCTORS have warned that new legislation on organ donation in Scotland is a missed opportunity to help the increasing numbers of people waiting for transplants.

The Human Tissue (Scotland) Bill, due to be debated by MSPs this week, proposes to strengthen the present 'Opt-In' system by placing more emphasis on following an individual's wishes on organ donation after their death.

It will also tighten up rules on postmortems and the retention of body parts after scandals such as that surrounding Alder Hey children's hospital in Liverpool, where organs were kept for research without parental consent.

But the British Medical Association (BMA) in Scotland has said the organ donation proposals contained in the bill do not go far enough. It is calling for a system of presumed consent to be introduced to increase the number of organs available. This would allow donation to automatically proceed unless someone had registered their objections, or their relatives opposed it.

According to the BMA, between April 2004 and March this year 52 Scots died while waiting for an organ transplant. Others have died without even reaching the waiting list. While more than 90% of the population supports donation, just over a fifth have actually signed up to the organ donor register.

Dr Peter Terry, chairman of the BMA in Scotland, argued there was greater public support for organ donation and transplantation than for the recent ban on smoking in public places.

But he said: "At the time of death, especially with a young person in a road traffic accident or whatever, it is very, very difficult for all concerned to ask relatives, and for the relatives to make a decision if they haven't discussed it or know the wishes of the individual."

He added: "The primary reason [for presumed consent] is to get more organs for the people who need them and it also, I think, would make it much easier for the relatives."

Terry said that in countries where such an 'Opt-Out' system had been introduced, there had been a substantial increase in the number of organs available for transplant and public backing for the move.

"We certainly don't want to push or persuade anyone who is unhappy about organ donation," he said. "We don't in any way want to influence those individuals, it is their right to choose what happens, but because people die without thinking about it an awful lot of organs are lost."

Similar legislation introduced recently south of the Border ruled out a presumed consent system, but Terry argued this was an opportunity for Scotland to lead the way.

"If the Scottish Executive doesn't think there is public support for it at this stage, then I would like it to prove that to us," he said. "But I don't think that is true. We're satisfied that there is great public support for this, we think others are just making a gut reaction-type judgement."

A spokeswoman for the Scottish Executive said it shared the BMA's concerns and had launched awareness campaigns to try to address the problem. But she added: "We know from the public reaction to recent organ donation issues that, for many people, presumed consent does not count as a valid form of consent."

Other medics believe there should be greater discussion of the issue, however. Dr Mairi Scott, chairwoman of the Royal College of GPs Scotland, said that while she understood the reasons for presumed consent, it was a 'Difficult area'.

"I personally don't think we have had sufficient public debate on this issue," she said. "At the moment we don't have an opinion either way, but what we do want is to make sure that the public has that chance."

The Scottish parliament's health committee last week backed the bill. Convener Roseanna Cunningham MSP said that although there was some debate about the merits of presumed consent, the majority of members had agreed the case for introducing such a system had not been made.

She said: "It was, I think, quite rightly pointed out that when we talked about presumed consent a lot of the medical profession would be wary of it because of concerns about what was the Alder Hey scenario."

Under the new bill, the current system of consent -- where relatives are asked if they want to donate the organs of their loved ones -- will be replaced by one of authorisation.

Adults and children over 12 will authorise the removal and use of their body parts after their death by signing up to the organ donor register or carrying a donor card, for instance. If the person died without giving instruction, their nearest relatives will be asked what the person would have wanted and can authorise the donation.

Cunningham said it would be vital to have widespread awareness campaigns to ensure the public knew the importance of expressing their wishes.

She said: "They will have to make sure this change does get across as it is going to be incumbent on surviving relatives to basically be indicating what the person's views are, so it is very important to make views well known."

The new legislation will also revise the rules on postmortems and the retention of body parts . Authorisation will be essential for hospital postmortem examinations, and will be required if organs are to be retained and used for research or training.

Parents of children whose organs were retained without permission in the past have welcomed the bill. Geraldine MacDonald, chairwoman of the Scottish Organisation Relating to the Retention of Organs, said it would ensure such scandals did not happen again. "It will be clarity for everybody," she said.

However, one expert has warned vital research could be hampered by the consent requirements. Professor Sheila Bird, of the Medical Research Council, argued testing for vCJD at postmortems should be allowed without the permission of the deceased or their family so that the prevalence of the disease in the general population can be assessed.

"The testing for late disease that was not overtly clinical was extremely important in cattle because it showed in the UK we had about three times as many BSE infections as we originally thought," she said. "There is a concern that ...reliance on just clinical cases to tell us about these epidemics is insufficient."

Copyright © 2005 Newsquest (Sunday Herald) Limited.

This article posted December 24, 2005.