Organ transplantation is an area that has seen amazing medical achievements but has not yet reached its full life-saving and life-transforming potential.
The transplant community has worked tremendously hard to increase donation rates, with significant support from the Scottish Government. But as a doctor it is difficult to see my patients dying and suffering when their lives could be saved or dramatically improved by a transplant.
Last year the BMA published the report, Building on Progress: What next for organ donation policy in the UK? It considered what more can and should be done to improve organ donation rates in the UK. Can we say we have done all we can? Or, should we now look to go further and build on the progress already made to look at new ways of increasing the number of donors and lives saved?
In Scotland, almost 650 people are on the transplant waiting list; some of whom will die while waiting. Others will have died before an organ is available. Meanwhile, repeated studies show up to 90 per cent of the population supports organ donation, yet only around half sign up to be donors.
We believe genuine choice over organ donation can be given through a soft opt-out system whereby adults – who have been well informed of the options – can choose to opt out of organ donation during their lifetime, rather than having to opt into donation, as it is now. A culture in which donation is discussed openly and seen as the norm would fit better with what most people say they want to happen. Rigorous safeguards are imperative to such a system, in order to ensure the protection of genuine choice.
This is how a soft opt-out system could work: before the new system is introduced there would be extensive and high-profile publicity to ensure all members of society were aware of the forthcoming change and to encourage them to consider their own wishes about donation after their death.
A database would be established with mechanisms for people to easily and quickly opt out if they wish.
Once implemented, when someone over the age of 16 dies and donation is a possibility, the opt-out register must, by law, be checked. If the person had opted out, donation could not proceed.
As an extra safeguard, if the individual had not opted out, family members would be asked if they were aware of any unregistered objection. If relatives were not aware of any objection, they would be told that donation would proceed. There’d be scope not to proceed if it became evident it would cause severe distress to them.
Under an opt-out system individuals have exactly the same choice as under an opt-in system but the default position changes. Unless an individual objects to donation their organs should be used after death to benefit others. We support the principle that everyone has, and would retain, the right to refuse to donate their organs after death and to have that wish respected. Under the current system there is no formal mechanism for people who feel strongly against organ donation to register their objection. In the absence of such a mechanism the current system makes it impossible to be sure patient autonomy is respected.
The BMA believes opt-out would enhance individual choice – by giving extra protection to those who do not wish to donate and making it more likely that those who are willing to donate will be able to do so.
If properly implemented, with adequate resources and staff, and backed up by a high-profile publicity campaign, an opt-out system could save or transform thousands of lives. All the time we waste now means more lives will be lost. Now is the time for a serious debate about moving to opt-out.
Dr Sue Robertson is a member of the BMA’s Scottish Council and works at the Renal Unit of Dumfries and Galloway Royal Infirmary