'Stop families' from overriding donor consent

The NHS is considering preventing families from overriding the consent of people who have signed the organ donor register.

NHS Blood and Transplant (NHSBT) says it wants to ensure a person's wish to donate is honoured if they die.

In a strategy document it also asks whether those on the organ donor register should receive higher priority on the transplant waiting list.

The strategy has the backing of the four UK health ministers.

It aims to build on the 50% increase in deceased donation rates since 2008.

NHSBT says it wants a "revolution in public attitudes and behaviour" so that individuals and families will be proud to support donation.

It says knowledge of organ donation remains low outside the NHS but this can be increased through education and publicity campaigns.

The aims of the strategy are to:

• Improve consent rates from relatives to above 80% (currently 57%) in all cases (families are asked to give consent whether their relative has signed the organ donor register or not)

• Bring the deceased donor rate up to 26 per million of the population (currently 19 pmp)

• Increase the number of patients receiving a transplant to 74 per million of the population (currently 49 pmp)

Almost everyone would accept a transplant organ if they needed one - but only 57% of families agree to donation when asked.

Grieving relatives sometimes overrule the wishes of patients who have signed the organ donor register - although this usually happens when families are not aware of a loved one's wishes.

NHSBT says a shift in behaviour is needed comparable to the changes achieved in preventing drink-driving or smoking cessation.

It says the UK will examine systems - such as in the US - where families are not permitted to override pre-existing consent so people can be confident their pledge to donate will be respected.

Dr Paul Murphy, from NHSBT, said: "When a family says no to donation it means someone's hopes of a life-saving transplant are dashed. They need to understand the consequences of refusal."

Although there are more than 19.5 million people on the Organ Donor Register, most will die in circumstances where organ donation is not possible.

NHSBT says it should also be possible to increase the numbers of people who are able to donate by reviewing end-of-life care procedures. One example is a pilot study in Scotland which gives the option of donation following cardiac arrest and failed resuscitation.

Serious debate

The strategy calls for a national debate on proposals to increase organ donation. For example it wants to know whether the public would support a system similar to the one in Israel and Singapore where those on the organ donor register get higher priority if they ever need a transplant.

Sally Johnson, Director of Organ Donation and Transplantation at NHSBT said: "We need to have a serious debate in our society about our attitudes - is it fair to take if you won't give? Is it acceptable that three people die a day in need of an organ? Is it right to allow our organs to be buried or cremated with us when they could save or improve the lives of up to nine people?"

Last week the Welsh assembly voted to change to law to bring in an opt-out system of organ donation in 2015. Wales will be only UK country where individuals will be presumed to have consented for their organs to be donated unless they opt out.

There are around 7,300 people in the UK waiting for a transplant. Last year there were 1,212 deceased donors.

NHSBT says the waiting list "considerably under-represents the true number of people who could benefit from an organ transplant".

It says evidence suggests the demand for transplants is likely to continue to increase in years to come.

BMA response to UK wide strategy on organ donation

Dr Tony Calland, chair of the British Medical Association's ethics committee, said donation should become a natural and expected event.

He added: "The BMA believes the best way to achieve this is through the introduction of an opt-out system for organ donation, similar to that planned for Wales from 2015.

"We need to monitor the situation in Wales but we cannot wait until 2015 to take action, we should be encouraging an informed public debate about opt-out now so that once the data are available we are ready to move forward in other parts of the UK."