Opt-out organ donation ‘seriously flawed’ warns bioethicist

Plans to increase the number of organ donations by switching to an opt-out system are flawed, a senior bioethicist has said.

In a letter to the Guardian Katharine Wright questioned the perceived wisdom of increasing donations by making everyone a donor by default.

She said that an opt-out system alone would not drive up donations, and that the Government would have to implement a number of other methods.


Wright clarified that in England it is not a requirement that someone must opt-in in order to donate an organ as their organs can still be donated if their family gives consent.

She said that for organ donation rates to increase, the Government needs to ensure they make sure families are involved in the process.

The bioethicist debunked the notion that the success of Spain – where organ donation rates are among the highest in the world – are a result of an opt-out system.

She said, “in fact, there is no Spanish opt-out register: people ‘opt-out’, if they wish, through their families”.

Heavy investment

Wright instead suggested that increased public awareness and improved system infrastructure should be credited with Spain’s success in maximising the number of organs that can be successfully transplanted.

She said that if the Government is set on introducing an opt-out system, “we must therefore be prepared to invest more in staff training, more specialist nurses to support families, and in raising public awareness”.

“These are things that we know make a difference to those in the difficult position of deciding whether or not to donate a loved one’s organs, and ultimately to those in need of a donated organ.”

Public awareness campaigns

The bioethicist’s remarks reflect the argument put forward by The Christian Institute, which has opposed the Government’s plans, saying the opt-out system turns people’s bodies over to state control, and overrides families.

In its response to the Government’s consultation, the Institute, said the Government would need to run major, cross-platform advertising drives about the new rules – such as ongoing public health information campaigns – to maintain a high level of awareness.

“These will have to have much greater visibility and saturation than anything to date under the opt-in system. The fact that the State presumes to take citizens’ organs after death will have to be taught repeatedly in schools.”

Overriding families

Last week, the Scottish Parliament’s health committee heard that healthcare professionals must not be forced to override the wishes of families if a new opt-out organ donation system is introduced.

Experts told MSPs that doctors and nurses would be put in a “very difficult” position if any rules compelled them to ignore the desires of grieving families.

Policy Adviser for the Royal College of Nursing Scotland Rachel Cackett said the college’s position is that “if a family does not want a donation to go ahead it should not be forced”.

Mary Agnew, Assistant Director for Standards and Ethics at the General Medical Council said: “I don’t think you would want to put professionals in a position where it was felt they had to somehow override a very distressed family”.

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