Saturday, August 25, 2007


The Chief Medical Officer (CMO), Sir Liam Donaldson, is the UK Government's principal medical adviser and the professional head of all medical staff in England. He produces an Annual Report which is used to bring to the public’s attention, matters which he thinks are critical and urgent in realtion to the Country’s health.

This year, one of the subjects he addressed was Organ Removal and Transplants. He put forward his views on how the shortfall between the number of people waiting for an organ transplant, and the number of organs actully supplied from those who currently have registered their names on the NHS Organ Donor list, should be changed.

At present the law is enshrined under the Human Tissue Act 2004, which came into force in 2006. An organ can be removed from a dead person if that person is either on the NHS Organ Donor List (it currently lists 13 million people) or has given their consent prior to their death. If neither of these are the case, then the consent of a nominated representative, or a close relative is required. The CMO’s argument is that if a relative knows that a patient wants to donate their organs after death, the relatives will be much more likely to agree. Otherwise, if the wishes are not known, then relatives will refuse in 30% of cases.

He also cites a study which indicates that although 20% of the population are on the NHS list, some 70% of the population actually want to donate their organs after death. His conclusion is that the current “opt-in” system should be changed to an “opt-out” system ie you are assumed to be prepared to donate your organs unless you specifically record on a National Database that you don’t want to do it.
As an aside here, it does seem strange to be questioning a law which only came into force last year.

Spain has already changed to an "Opt-out" process similar to the one the CMO is advocating, and not unsurprisingly, their rate of organ donation has increased significantly.

This raises yet another area of Government takeover, this time of our bodies. Now I can quite understand anyone deciding that donating their organs to help others is something they wish to do. I can also argue that one’s body is one’s own, and in the final analysis, it is yours and yours alone to decide what happens to it when you die.

What perturbs me about the CMO’s argument is that, although 20% of the population are already on the NHS list, and a further 50% would be prepared to donate their organs, that still leaves 30% of the population who do not want their organs used for this purpose. Unless that 30% firstly even knew about a change in the law, and secondly found out how to register their non involvement, then those people, or their relatives, would be in for a very difficult time if the law was changed, when a medical team arrived to remove a heart or a kidney from someone close who had just died.

There are probably several reasons why there is a 50% level of people who want to donate their organs, but who have not signed up with an organ donor card, and one of the largest is probably apathy.

If you changed the law to be the reverse of what it is today, I would imagine you’d still get a similar level of apathy, combined with a lack of public knowledge about the change to the law. I can easily imagine that the advertising level put in place by the Government to explain the “opt-out” position would not be that high, seeing it’s diametrically opposed to what they are seeking to do.

Simplistically, that would leave around 15% of the population, ie c8 million people being duped by a change in the law, and put in a position they do not want to be in.

So what’s the answer? I would have thought it not beyond the whit of man, to ask everyone in the country to fill in a form to discover actually what each individual thinks. We do something similar when we vote – so what’s so difficult here? We even have something like 50% of the population with Internet access, so why don’t we start to use this medium for getting answers to questions like this. It’s not political, it’s simply an individual’s opinion, and if the Government really is concerned only to have those on the register who truly want to be there, it seems a simple enough task to do it correctly. So why don't they do it?

As always with such things, the issue is usually more complex and subtle than those in power want us to believe. If you are presumed to have opted in, then it is all too possible for the Hospital removing an organ from someone who has just died, to want to go ahead speedily. Time is hugely of the essence here, and it is literally an area where minutes matter. Checking on a database, which, if the Government’s current record is anything to go by, is quite likely to be riddled with serious inaccuracies, is likely to be rushed, with the obvious possibility of a major and rather binary error. Just imagine a relative voicing his opinion and saying one thing, only to be overridden by a Hospital administrator who says the opposite, because "that's what the computer says". You just know the outcome of that one.

And it may have been coincidence, but a couple of days later, we read in The Times, of a Doctor, albeit in America, who has been charged with deliberately hastening the death of a disabled man, so that he could “harvest” (sinister word, or what?) the man’s kidneys for the benefit of another patient.

The rules in this area are quite strict, in that there is supposed to be a “very high wall” between those managing the patient’s care, and pronouncing death, and those who trigger any activity regarding organ donation. In my view, the slightest whiff of any collusion or osmosis across the wall here, is a potentially major downside to an “Opt-out” system.
You could even understand people starting to worry if they carried a Donor Card, or were on an Organ Donor register, that this would potentially open themselves up to a different range of treatments, when it would be just the moment when they needed everyone pulling their hardest for them.

Here we have another example of the State wanting to push its own boundaries of Control forward, and restrict further the rights of individuals - at first sight, it would seem, for the best of motives, but who knows, when there's a target to meet.

My view is simple – It’s my body, and it is my right, not a politician’s, to do what I want with it when I die. Those in power should not be looking to override that position, by presuming firstly on my lack of knowledge, and secondly on my apathy.



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