A straw poll on your views about this tricky ethical issue please.
Gordon Brown recently brought the subject of transplants back into the news by supporting a similar system to the Spanish, who have the highest organ transplant rate in the world. The system is effectively an ‘opt-out’ arrangement and deceased patients with no specific instructions are ‘presumed’ to have given consent for their organs to be used.
The argument for:
More and more patients are dying on transplant waiting lists. Many of these people are young, with congenital conditions like cystic fibrosis, primary liver cancer or autoimmune kidney disease meaning they need new hearts, lungs, livers and kidneys. Less people are dying in road traffic accidents due to improved road safety, but this results in a decreasing source of healthy organs.
No replacement therapy can compare with a transplant. A patient might be tied to a dialysis machine for several hours three times a week, on a cocktail of drugs for anaemia and bone disease and unable to live a normal life. A new kidney is life-changing, just like a new heart is better than any artificial device we have manufactured. One dead body can change several lives.
We are developing the ability to transplant more and more parts of the body, corneas, pancreatic components (for diabetics), skin, hands, eyelashes and faces. Around 8,000 people in the UK are currently awaiting organ transplant and the number grows by 8% a year and it’s not improving. 1000 are estimated to die each year on organ waiting lists.
Three quarters of the public say they would be willing for their organs to be used, yet only a quarter register for this. At present approximately 40% of relatives refuse consent for their deceased loved one’s organs to be used. There is no clear reason why the next of kin should automatically have say over someone’s organs, yet we currently listen to them.
Once someone is dead, they are dead. Eastern cultures such as Parsis and some Tibetan Buddhists have traditionally allowed their dead to be consumed by vultures. Hindus cremate. However, black and ethnic minority donors are pitifully low in number. Renal transplants cost the NHS less than dialysis after a few years.
Recycling is fashionable.
The argument against:
Can you really assume consent for anything? Herein lies the ethical stumbling block, what are the rights of the dead? As many people define death in different ways, feelings differ markedly about whether a dead body is ‘sacred’ or not. Dominic Lawson today made a (in my opinion, somewhat flawed) analogy to necrophilia in the Indy. He said how could we support presumed consent for organ donation when we are revulsed by the idea of someone having sex with a corpse? Surely consent could be assumed in both situations or neither.
Spain’s enviable record of transplant rates has not been directly linked to their consent law. They have an admirable and highly developed transplant network, with more 24 hour-harvest teams and way more road deaths than the UK. If we suddenly increase the number of transplants occurring (the patients are often highly dependent post-operatively), the NHS probably would not be able to cope without more units being opened and existing ones being expanded.
The definition of ‘legally dead’ or ‘brain dead’ is debatable.
The government has announced that more hospitals will have dedicated transplant co-ordinators, whose job description includes persuading families a soon-to-expire relative can save someone’s life. In Spain they have been credited with halving the refusal rate.
What do you think?
Disclosure: I am currently a transplant doc.
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