Push for more progress on organ donation

A record number of organ transplants were carried out in the UK last year

In asking new drivers whether they wish to join the organ donor register, the government is attempting to reduce the gap between those believed to want to donate their organs and those who actually commit to doing so.

The move has been widely welcomed but, for some, it does not go far enough.

The NHS Blood and Transplant (NHSBT) service believes it will make an often difficult decision for relatives much easier.

It says 90% of people support organ donation despite only 27% of the UK population being registered donors.

Since many people do not inform family members of their wish to donate their organs, sometimes relatives opt not to give consent.

Paula Aubrey, team manager for the NHSBT's London Organ Donation Services Team, said: "We know from practical work if the relatives know the person who has died wanted to donate organs it makes the decision so much easier for them.

"What we know in the UK is a lot of people want to donate their organs but just don't get round to signing up.

Support 'growing'

"We have no margin to miss any person who would want to donate."

Under the Driver and Vehicle Licensing Agency's "prompted choice" system, applicants will either have to register to donate, say they have already signed up, or select an option which states they do not wish to answer the question.

The existing system allows applicants to skip the question completely.

The British Medical Association (BMA) has backed the planned revision, calling it a step in the right direction, but the body is also among those pushing for bolder action.

The BMA would like to see a system of presumed consent, where the assumption would be made that all people wish to donate their organs unless they have chosen to opt out.

It wants donation to become the default position and says "public support for such a change is growing but we need to continue to raise awareness and encourage public debate".

Dr Tony Calland, chairman of the BMA's ethics committee, is pressing for a system of "soft presumed consent" where organs would only not be used if there was "extremely strong" opposition from relatives.

Similar systems have been introduced in other countries, with varying degrees of success, he said.

"Austria and Spain are the two main ones that have a system of presumed consent and it seems to work really well there," Dr Calland said.

'A disaster'

Prompted choice schemes in the United States have also increased donor registrations significantly.

But Dr Calland added that in countries where governments had failed to educate people sufficiently about the measures, and where issues such as religious beliefs were more of a factor, there had been problems.

"In Brazil they introduced presumed consent overnight and people weren't informed, they didn't understand it… and the whole thing was such a disaster that it was withdrawn and changed back again after a relatively short period of time," he said.

In 2008, the Organ Donation Taskforce said a 50% increase in organ donation was achievable in the UK within five years, but it stopped short of recommending an opt-out system.

The British Heart Foundation (BHF) called the driving licence pilot "a welcome step forward", but it too is warning that it will not solve the shortage of organs.

Betty McBride, director of policy and communications at the BHF, said: "We believe an opt-out system should underpin organ donation.

"This would ensure that there are many more organ donors available and ultimately save lives."

Dr Evan Harris, a former Liberal Democrat MP for Oxford West and Abingdon and a former hospital doctor, said the prompted choice pilot would still allow people to "skip the question" of donating their organs by selecting the "I do not want to answer this now" option.

He is another fan of an opt-out system, which he says has "every possible advantage".

"I think ethically the default should be to save lives.

"It's not difficult to convince people to go on the organ donor register when you sit down and talk to them.

"But I think most people don't like to talk about their own mortality. People are willing to donate but aren't necessarily willing to think about it."

Dr Harris said increasingly relatives were refusing to allow organs to be used because they wrongly assumed their loved one did not wish to be a donor.

"If relatives find their loved one is not on the register they just think 'well he mustn't have wanted to'," he said.