We need more sensitivity over organ donation issue
With organ retention scandals still fresh in people's minds, any discussions involving human organs will be greeted with suspicion by the public. The Government has recently initiated a debate on whether the UK should embrace an opt-out rather than opt-in policy regarding the donation of organs for use by others after people die.
The proposal is that rather than sign a form to volunteer to be an organ donor, individuals would instead have to confirm in writing that they did not want their organs to be used. The family of the deceased person would also still have the right to refuse the use of the organs.
Safeguard
Statistics suggest that when asked, most people claim to be happy for their organs to be used to save others, yet only one quarter of the population register to do so. If more people registered as donors, more lives would be saved.
However critics suggest such a change could alter the relationship between the state and the individual.
Some are ideologically opposed to the Government interfering in matters such as this. Without proper safeguards, it could seem as if the NHS were claiming ownership of our bodies.
Some would argue our bodies should remain our own even after death, that this is a private decision and must be voluntary. Many feel that maintaining dignity in death precludes tampering with the body. However, this is an unpleasant experience already thrust on many grieving families on account of the legal requirement for a postmortem examination in many circumstances.
Guarantees
The detail of how an opt-out or 'presumed consent' system might operate would have to be debated exhaustively. A sense of mistrust of the medical profession lingers, following the organ retention scandals such as Alder Hey and closer to home at the Royal Victoria Hospital in Belfast.
Very rigorous clinical protocols would have to determine at what point organ donations could even be contemplated. What safeguards would there be to prevent excessive pressure on the family from health care staff desperate to acquire the potential for life for another desperately unwell patient?
It is an extremely difficult situation for relatives. What guarantees would they have that the organs and other body parts would be treated with dignity?
On the other hand, many organs currently go to waste, simply because individuals have not made clear their wishes to donate during their lifetime. Many ill patients could look forward to survival and decades of good health if the system was altered.
More than 400 people will die this year while they are on the waiting list. Another 500 will be on the list but then taken off to die, because they deteriorate and become too ill for a transplant. An unknown number die without ever having made it onto the list.
Currently, there are 9,600 people on the waiting list to receive a transplanted liver, kidney, heart or lungs, but last year only 3,100 organ donor operations were carried out. Demand has grown.
In 1995, fewer than 4,000 people needed a new kidney. Ten years later, that number was 5,736 and continues to grow each year as more are diagnosed with renal disease.
In stark terms, three people a day are dying while on the waiting list for a transplant as the demand for a new organ outstrips supply.
Fewer organs are available.
Improvements in road safety thankfully mean fewer traffic accident deaths. Potential donors must meet stringent conditions. They cannot have serious internal injuries and the organs have to be intact. Only those whose death is confirmed by brain stem test can be considered. There can be no possibility of infections such as HIV or CJD.
A study published in the British Medical Journal in 2006 found that of 46,000 patients, only 2,740 of them fitted the medical criteria to be potential donors.
Lowest
Just 1,244 actually became donors, mainly because relatives refused to allow it. We have one of the lowest organ donation rates in the Western world, and therefore one of the lowest transplant rates.
The Spanish have 34 donations occurring per million of population, as opposed to 13 per million in the UK.
Spain and other European countries operate the 'soft' opt-out system, where relatives' views are sought and they can refuse consent, even if the deceased person had been happy to donate. Austria however has a 'hard' opt-out system, with the views of relatives not taken into account at all.
A poll carried out in May 2005 found that 61 per cent of those questioned in the UK supported a change to an opt-out system, up from only 26 per cent back in 1999.
The report of the taskforce set up by Alan Johnson (Secretary of State for Health] states that the first step should be for the NHS to provide highly-skilled organ co-ordinators who would be able to talk with sensitivity to relatives at the bedside of their loved ones.
They believe that there could be a 50 per cent increase in donated organs if hospitals became better at handling these sensitive conversations.
There are undoubtedly many examples where the tragedy of death has led to priceless opportunities for others to live.
Indeed, it allows many families to see something positive come from their loss. However, I have seen at first hand the immense grief and torment that the secret retention in hospital of the body parts of a relative has had on constituents.
This illustrates to me how deeply personal these issues, and any public discussion around them, can prove to be, and the level of soul-searching they demand.
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Monday 13 February 2012
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