Nuffield Council on Bioethics raises concern over the lack of evidence to support Government’s planned move to opt-out organ donation

Today, Parliament will debate the Organ Donation (Deemed Consent) Bill, which proposes to move to an ‘opt-out’ system of consent for organ donation in England.

The Nuffield Council on Bioethics strongly supports organ donation where this aligns with the wishes of the donor. However, we are concerned that the Government is making a legislative change that is not based on good evidence. The Government has claimed that the move to opt-out will ‘potentially save thousands of lives’, however research from the Welsh Assembly Government, who introduced opt-out organ donation in 2015, shows that “the introduction of opt-out has, as yet, had no impact on the number of organ donors in Wales”.¹

On the other hand, there is good evidence regarding the role of a number of other factors in increasing the rate of donated organs: better support and communication between specialist nurses and bereaved families, raising public awareness, and encouraging family discussion.

Spain is often seen as the gold standard model for organ donation. However, although their law technically allows for an ‘opt-out’ approach, they do not operate an opt-out register, and their high organ donation rates have instead been attributed to better infrastructure and respecting the wishes of the family.

The Director of the Spanish Organización Nacional de Trasplantes, has called presumed consent a ‘distraction’ and attributes Spain’s high organ donation rates to better infrastructure and respecting the wishes of the family, not ‘presumed consent’.²

Director of the Nuffield Council on Bioethics, Hugh Whittall, said: “We fully endorse the aim of increasing the rate of donated organs, but we are concerned that making a legislative change based on poor evidence risks undermining public trust in the organ donation system, and could have serious consequences for rates of organ donation.”

Notes for the editor

The Nuffield Council on Bioethics is an independent body that examines and reports on ethical issues in biology and medicine. In 2011 it published a report Human bodies: donation for medicine and research which considered the ethical and social issues that arise when people are asked to donate bodily material such as organs, blood and gametes. It recommended that robust research is needed on the effects of an opt-out system for organ donation if introduced in Wales, in order to obtain a clear evidence base for any proposals for change elsewhere in the UK.

Footnote

• Welsh Government (2017) Evaluation of the Human Transplantation (Wales) Act: impact evaluation report, available at http://gov.wales/docs/caecd/research/2017/171130-evaluation-human-transplantation-wales-act-impact-en.pdf.
• See Fabre J, Murphy P, and Matesanz R (2010) Presumed consent: a distraction in the quest for increasing rates of organ donation The British Medical Journal, available at: http://www.bmj.com/content/341/bmj.c4973.full