October 1, 2022

Why presumed consent failed the test in the UK

Member of task force explains

from The EconomistIt was the fury of British Prime Minister Gordon Brown over the failure of his pet project of opt-out organ donation which made the news earlier this month. The reasons why the "organ donation task force" decided unanimously that it was not a good idea were almost buried.

According to Vivienne Parry, science writer and broadcaster and member of the organ donation task force, nearly all the reasons centred on trust in the medical profession: "Trust that our organs will not be taken until we are really dead, or that treatment for the critically ill will not be pursued less vigorously if they are seen as potential donors. These fears are misplaced but they are primeval, akin to those we have about being buried alive," she says in a column in the London Times.

In effect, presumed consent is a vote of confidence in the medical profession, that it will always act in the best interest of the patient. However, as a result of some high-profile medical scandals, it may be that patients trust doctors less nowadays. Lack of trust actually led to the repeal of a presumed consent system in Brazil in 1998 after a single year.

Practical problems abound. Since organ donation is regarded as a virtuous act, opting out might be viewed negatively. The register of those who opt out would have to be highly confidential. But after several terrible breaches of IT security, can anyone in the UK trust the government’s ability to keep these registers secret?

Then again, can the government really presume the consent of the mentally incompetent, the homeless, and visitors to Britain? Many people, too, might be happy to donate a kidney, but not a heart, or some of the other 70-odd tissues which can be donated. Which organs does presumed consent cover?

Nor is Spain, a country which uses an opt-out system and has the highest organ donor rate in the world, 34.4 per million, necessarily a good model. The US has the second highest rate, 26.6, and it has no presumed consent system. Greece has an opt-out system and its donor rate is a miserable 5.6. In fact, Spain’s rates only rose when an effective transplant infrastructure had been set up, along with a powerful public education campaign.

"There are surer ways to increased donation than presumed consent. Let’s take them fast," concludes Ms Parry. ~ London Times, Nov 18