Organ Donation

At least 10 people die every day, while waiting for a major organ for example, heart, lungs or kidneys’, the reason being they is a massive shortage of organs across Europe, with the transplant waiting list growing, they is need for radical measures to be taken. The author of this easy will define what organ donation is, however the aims of the essay is to compare and contrast the two systems of organ donation, the opt- in and opt- out systems. The focus of the essay is on cadaveric donors,( heart beating donors and non- heart beating donors). The author will also go on to explore their personal views on organ donations, from before and after researching the topic and then reflect on how those views may have changed.
Organ donation is defined as the donation of a biological tissue or organ of the human body, from a living or deceased person to a living recipient in need of a transplant. The removal of the organs is carried out in accordance with The Human Tissue Act (2004) who “regulate the removal, storage, use and disposal of the human bodies, tissues and organs”, (DOH ,2004).Organ donation is a complex issue, one which involves factors such as ethics, legal, organisational and societal factors. Much of the debate surrounding organ donation is the issue of consent /autonomy and trying to find ways to increase the number of potential organ donors. Do we choose to preserve the rights of the dead or those of people who are in pain? Across Europe they are two systems in practice, namely presumed consent (opt-out system) and informed consent (opt- in system).Although the two systems are different in practice, there main objective is the same, to increase the number of potential donors, which in turn would reduce the number of people on the waiting and the number of people who die while on the transplant waiting list.According to the at least 1000 people die every year while awaiting an organ.
The main difference between these two systems is how they view consent, the opt –out system assumes consent, the state automatically assume that every individual is a willing potential donor unless they take explicit steps to make their objections known. They are two types of the opt- out system: soft opt -out and hard opt -out systems. The soft opt- out system the doctors will take into account the wishes of the family, especially in cases were the decision would cause distress to the family. Spain, France and Belgium are example of countries that practice this system. Hard opt –out system the doctors can remove organs unless the person had registered their objection, the views of the relatives are not taken into consideration, Austria, Switzerland and Poland practice this legislation. However regardless of what system is in practice it is viewed as good practice to seek consent from the families, example in Spain they will not remove organs from a deceased person, even though they can from a legal standing.
Whereas opt-in system a potential donor has to take steps to make their wishes known by registering on the Organ Donor Register, this system is currently practiced in UK, New Zealand and other European countries. They also is a soft opt in system were the relatives have the final say, regardless of the deceased wish.

currently in the United Kingdom the organ donation policy requires potential donors to opt-in. the potential donor can do this either by registering via the internet, mail (filling in forms), telephoning and also when applying for a driving licence, then they would be issued with an organ donor card. However an organ donor card is not legally recognised, even though a person has made their wish known a family member can override that decision and also people do not always carry donor cards on their person. Within the current system there is a major shortage of organs for transplantation, as it stands they are around 8 000 people on the national transplant list, which has been reported to be increasing by 8% every year, (DOH ,2008).Yet only 29% of the population are registered as organ donors. This increase has been attributed to the aging population and increasing incidents of type 2 diabetes which in some cases can lead to kidney failure, which will increase demand for organs,( organ donation taskforce, 2008). The aging population takes away from the donor pool as people get older the majority of them may suffer from ailments that might prevent them prevent them from donating for example high blood pressure which can affect the kidneys’ and the heart, arthritis and others.

They is evidence to support that the opt- out system can increase the rate of donors. Research carried out by (Abade and Gay, 2006) indicates that in countries who operate an opt- out system had a higher average of 17.29 donors per million population compared to that of 14.29 donors per million population of opt- in system. In the UK we have 12.8 dead organ donors per million population compared to that of Spain which has 35.1 donors per million population, (English,2007). According to Matesanz et al 1996; Matensanz and Miranda 2000, there is a positive effect on rates in countries like Spain, Austria and Belgium who practice the opt- out system. Hence the recommendation by Sir Liam Donaldson ; CMO annual report 2007,that the UK ought to move from opt-in system to opt –out system, a Taskforce was set up to find evidence to support the move to presumed consent. The aim of the taskforce was to realise what impact presumed consent could have on the rate of organs and to also assess the public and health professions views on the issue in terms of support.
Spain is seen as the best example for soft opt- out system with the highest donors per million population however (Wright ,2005) argued that Spain’s success can not only be down to the legislation but the money that was invested in developing reliable infrastructure, staff for example skilled surgeons, organ donor co-ordinators in every hospital, education and support from the people. Another frequently cited example used to support the opt- out system is Belgium, two transplant centres, Antwerp which uses the opt-in system and Leuven which adopted the opt- out system. After three years, Antwerp maintained the same levels of organ donation, compare to that of Leuven which increased from 15-40 donors per year,( Kennedy et al ,1998).If the UK were to implement the opt- out system , it will not only be a matter of changing the law, but also an issue of funding as proved in Spain, they will be need for a major overhaul of the current infrastructure, an increase in the number of beds in the intensive care at present intensive care beds are 0.5% of total beds in the NHS, skilled transplant surgeons massive advertising campaign to inform those who do not wish to be donors.
The current system is seen as not being representative of the wishes of the majority of people, according to research 90% of the population are willing to donate their organs, and yet only 29% of the population are registered as organ donors, (UK transplant ,2008).Maistarch argued for the opt- out system ,his argument is that since the majority of the population support organ donation, presumed consent would be the “ moral way to proceed” acknowledging the unexpressed but autonomous “will” of the majority of the population. Within the opt- in system 67% of the population have not registered, meaning the decision on whether to donate is then left to the relatives of which 40% refuse to consent, due to being unsure of the deceased wishes, (BMA ,2000).It is easier for the families to assume that the deceased was against organ donation, since they did not register their wish. Some of the relative might impose their own beliefs or choices rather than those of the deceased. In comparison with Spain whose rate of family refusal is 20% and France with 30% refusal rate, (Barber et al ,2003).The default position makes it easier for the families to assume that the person was more or less open to the idea of donation since they did not register to be a non- donor. For the opt-out system to be a success it has to have the support of the people, the health professionals, an example of a country that failed to implement the system successfully is Brazil, even though they had legal justification .The doctors refused to remove organs without family consent.

According to research opt-out system will increase the rate of organs and also the quality of the organ which will result in a better outcome of the recipient.

Before undertaking this assignment, organ donation is not a subject I had given much thought too. Researching this essay made me challenge the cultural, religious, ethics and moral views I held about organ donation. I do not carry an organ donor card nor am I registered as a donor; however this is something I have now considered and have decided I want to do. After realising that at least 10 people die every day while waiting for an organ is has made me reconsider what is important, and however this has not always been the case. Before migrating to this country, I did not know anything about organ donation; I had never met anyone who has had an organ transplant. Some of my cultural beliefs are outdate and based on myths and superstition, especially when it is about death. Death is secrete, the dead are treated with the utmost respect and when one dies they are rituals that are performed that require the deceased to be whole, these rituals are carried out to prepare the deceased for the afterlife. The subject of death is a taboo.

Before undertaking this assignment, organ donation is not a subject I had not heard much about nor had I given much thought too. I had not realised how complex it would be for me to come to a decision, I had to overcome and try to reconcile my cultural and religious beliefs and ethical principles as they conflict. I also had to question my up-bringing and be prepared to challenge my family views. My attitude towards organ donation prior to researching the subject was shaped by my up-bringing and my culture, having grown up in a country where the health system is less than satisfactory and people believe in superstitions and myths. Death is not a subject that is openly discussed, death is secrete and the dead are treated with the utmost respect. In the African culture people believe in the after- life, therefore one has to be buried whole.
I found difficult trying to reconcile my religious belief and ethical principles with my cultural beliefs. As a Christian I feel obligated to help others, Christianity advocates giving, I cannot think of a better gift than giving someone a chance to live a fulfilling life. I do not have a donor card nor have i registered as a donor; however this is something I am now considering, I have not discussed my wishes with my family,
After having read about organ donation and the systems in practice, I am in favour of the current opt- in system even though they is evidence to support the opt-out system has a higher rate of organ donors than the opt- in system . Organ donation is an altruistic act; I strongly believe that donating organs should be a personal choice rather than one a government makes for everyone. It could be argued that, one still has a choice to make within the opt -out system by opting-out. I think for recipient it is easier to accept an organ that has been donated rather than that which has been obtained by position of default; this can impact on their recovery as it can change the gift- relationship. Rather than looking at changing the system I believe that the government should look at ways to maximise the current system in practice. For example intensive advertising campaigns and educating the public, by doing so that could help dispel the myths that surround organ donation. Showing the positives of donating organs and highlighting how many people are currently on the waiting list. There is need to teach young people about organ donation, making it part of the curriculum like sexual health. The more campaigns they are, it is likely that families might start to talk and discuss the issues. This might lead to organ donors to be viewed as the norm rather than the exception. With opt- in system an organ is an altruistic act, gift that

I agree with Professor John Saunders royal college of physicians’ ethical issues in medicine who is advocating for a “mandated choice “that is a legally-mandated decision, where all adults are required by law to indicate their wishes about their organs after death. I believe that if a person wants to be an organ donor they should make the effort to make their wishes known by taking the necessary steps in registering. With regards to both systems I see no point for their existence if your family can override your decision.

In conclusion this essay looked at the organ donation systems practiced across Europe the opt- in and opt -out systems, and how they affect the rates of organ donation.