The Nuffield Council on Bioethics today (4 September) calls for discussion around wishes for organ donation before and after death, and robust evidence before any change is considered to the law.
The latest figures from NHS Blood and Transplant on the number of transplant opportunities missed each year highlights the importance of having measures in place that encourage people to express their wishes during their lifetime with relatives, and that those wishes are documented, says the Council.
This and the involvement of specialist nurses for organ donation (SN-OD) in discussions with relatives at the appropriate time clearly have the greatest impact on consent rates for organ donation, says its Director at the start of National Transplant Week.
The evidence gathered so far does not appear to support the belief that ‘opt-out’ systems necessarily increase the availability of organs for transplant, as more than a third of families approached under the opt-out approach in Wales felt unable to give consent to donation.
Hugh Whittall, Director of the Council said: “The evidence points very strongly to the fact that decisions about deceased organ donation are most effective when they are based on the known wishes of the donor, and involve discussions between trained professionals and relatives.”
“Whilst there continue to be calls to introduce an opt-out system for organ donation, more evidence needs to be gathered over a longer period before deciding whether to extend this system to other countries.
“The key issue appears to be knowledge of the deceased’s intentions and skilled support in discussing the possibility of donation with the family, rather than the legal basis for donation.”
Table 13.1 of the National Potential Donor Audit covering the period 1 April 2016 to 31 March 2017, showed that rates of consent or authorisation were 68.6% when a specialist nurse for organ donation (SN-OD) was involved in the approach to the family. This dropped to 27.5% when they were not involved. When a SN-OD was involved in approach and the patient was known to be on Organ Donor Register at time of potential donation the consent rate was 92.6%. Whilst not directly comparable, a relatively high rate of refusal occurred when deemed consent applied, with a figure of 60.6% for the consent rate, meaning that donation was overridden by nearly two in five families who did not support deemed consent. This suggests that the key issue is knowledge of the deceased’s intentions and skilled support in discussing the possibility of donation with the family rather than the legal basis for donation.
The Nuffield Council on Bioethics is an independent body that examines and reports on ethical issues in biology and medicine. It was established by the Trustees of the Nuffield Foundation in 1991, and since 1994 it has been funded jointly by the Foundation, Wellcome, and the Medical Research Council.
The Council’s report Human bodies: donation for medicine and research, published in 2011, considered the ethical and social issues that arise when people are asked to donate bodily material such as organs, blood and gametes.