Surgeons warn over switch to donor opt-out system

The RCPE has questioned why family members can veto organ donations. Picture: Getty
The RCPE has questioned why family members can veto organ donations. Picture: Getty
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THE Royal College of Physicians of Edinburgh (RCPE) has warned switching organ donors to an opt-out system could remove the “altruistic aspect of donation”.

Experts have questioned why family members can veto organ donations amid research showing nearly half refused when the wishes of the deceased were not known.

Around 46 per cent of families vetoed organ donations in 2014-15 because they did not know if their relatives would approve, according to an NHS audit of potential donors.

Just 345 people were eligible donors out of about 54,000 deaths in 2014, the audit found.

The British Heart Foundation (BHF) said this demonstrates the current opt-in donor register “simply doesn’t work” in a submission to the Scottish Parliament Health Committee’s scrutiny of the Transplantation Bill.

The Bill would switch donations to an opt-out system, meaning organs will be taken routinely unless the deceased registers a prior objection or actively hands a loved-one – known as a proxy – a veto.

The committee will hear from BHF, the British Medical Association (BMA) Scotland, the RCPE and the Scottish Youth Parliament (SYP) 

RCPE has warned the Bill could be seen as state harvesting of organs and cause conflict between physicians and 
relatives. But BMA said Scotland must shatter “the myth” that organ donation should be regarded as “a gift” – and said the proposal to nominate a proxy seems complicated when people can just give prior authorisation when they are alive.

SYP said the proxy is particularly important for young people in care, whose decision-making capacity may be questioned but who may object to blood relatives making decisions on their behalf.

“Despite decades of campaigning to encourage people to join, and the fact that 90 per cent of the public say they support organ donation, the number of people on the register remains at only 32 per cent across the UK.”

It had no objection to the proxy proposal, saying people may want someone to support their choice other than potentially distant family who may not represent their views.

But RCPE said: “In a situation where a proxy confirms that the wishes of the deceased are opposed to the views held by the immediate family, clinicians could be placed in the very difficult position of harvesting organs in the face of explicit opposition from immediate family members.

“Some believe ‘opt-out’ legislation means acquisition by the state of organs.

“Removal of the altruistic aspect of donation is of real concern to some of our fellows, who feel that bereaved families take great solace from an active act of giving.”

The BMA said donation may provide comfort to families.