Soft launch for the soft opt out

What's the most high profile and complex piece of primary legislation that will come before the Assembly over the next few years?

What's the one draft Bill that will be scrutinised and discussed beyond all others in headlines, hospital canteens and in homes up and down the country?

What will drive home to people who don't live in Wales that devolution means politicians in different countries making different decisions about big things? Things like life and death.

It is, of course, the draft Human Transplantation (Wales) Bill, published today, and lauched at Leckwith Athletics Stadium in Cardiff. Now it's out of the blocks properly, it'll be subject to further consultation until September, before AMs vote on it next year. If a majority support it, then by 2015 the way we donate organs in Wales will have changed.

I'll home in a couple of things that hadn't been clear to me until today.

First off, the numbers. How many more donors would you expect to find if and when the law is changed?

Many of those who object to the change in the law don't point to moral concerns. Their argument is that legislation won't improve your chances of having an organ donation and in fact, it could make things worse. The charity CARE argues that presumed consent isn't just misguided. It will, they say, prove "ineffectual."

So back to the numbers quoted today. In Wales some 30,000 of us die every year. Of those the number who prove to be suitable organ donors is around 228 - a tiny percentage. These are the people who die in the sort of controlled circumstances, in hospital, in intensive care, that make donation possible.

Of those only some 67 become successful donors.

So, argues the Welsh Government, add 15 to that number - the expected rise in the number of donors under presumed consent - 15 people, 45 organs and that is not an insignificant number of lives saved, or money saved. 15 might not sound very much but purely in terms of cost to the NHS, just one single donor, argues the government, would make this policy worthwhile in cost terms.

Secondly: the role of families. Take a look at this blog from a few months ago and you'll see how many questions surrounded the role of relatives. Do they have a "veto" over a relative donating an organ, or not? It's crucial because for many people, the nature of that "veto" is a key factor in whether they embrace, go along with, or downright object to this policy.

Quick recap: as things stand now, the family have a veto even if the deceased relative has chosen to sign the Organ Donation Register. Surprised? Yes, so was I when that dawned on me during the last consultation.

So would that veto continue if the law is changed? After all, it's one thing for the Health Minister to say that she "cannot imagine organs being removed if a family refused permission". It's another to point to a piece of legislation and say that yes, they have a veto on the removal of the organ.

This is the explanation in a Q+A document published today:

"People close to the deceased will always have a very important part to play in any discussion about organ donation.

"In deemed consent cases, they are not required to give their consent to the donation itself, because the deceased's consent will have been deemed to have been given already. However, they will still be asked to give some formal agreements to parts of the process of donation, for example for blood tests to be carried out, or for the deceased person to be taken to theatre etc"

In other words they have no legal veto. In law, the wishes of the deceased person are paramount.

But if the family choose to object to any part of the clinical process then they can stop the donation from going ahead.

That sounds to me like an effective veto - if not a legal one.

I suggested this to Dr Chris Jones, the Medical Director of the NHS in Wales at this morning's briefing. He agreed but pointed to evidence that when presumed consent is introduced and organ donation becomes part of a country's culture, the numbers of relatives who choose to override that consent tends to diminish.

The Government is consulting on its draft legislative proposals from today until September. According to its published timescale, the aim is to have a vote in the Assembly early next year, thereby enabling it to hit the 2015 target for starting the system up.

Plausible? Privately, the feeling within the government is that while public opinion may have been 50-50 when plans for an opt out system in Wales were first mooted, there's been a definite swing in favour across a number of opinion polls in recent months and that they're now swimming with the tide in putting these proposals forward.

Additionally, today's legislation has written into it a requirement for Welsh Ministers to promote transplantation, as well as educating and informing the public about the way an opt-out system would work in practice.

It remains to be seen whether they'll also have to convince those within the UK Government who have reservations about whether the legislation put forward today is within the Assembly's devolved powers, and whether they feel strongly enough to step in before Royal Assent is granted and refer the issue to the Supreme Court.

Of course, if the number of donors does rise by the quarter predicted by the Welsh Government if and when the new system is introduced, then expect other parts of the UK to start looking seriously at emulating these proposals.