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Organ Donation and Legislation

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02 Jul 2015

As Wales moves to become the first country in the UK to introduce soft opt-out legislation for organ donation later this year, RCSEd Fellow, Honorary Consultant Transplant Surgeon and Senior Lecturer in Transplant Surgery at University of Edinburgh Lorna Marson examines the issues surrounding the debate on whether there should be legislative change throughout the UK to support soft opt out in order to increase the number of organs available for transplantation.

Transplantation is the best option for many patients with end-stage organ failure, improving survival and quality of life. Despite a significant increase in the number of organ donors in the United Kingdom over the last 5 years, there remains a shortfall between supply and demand.  It is imperative that we work together with the UK governments, the charity sector and colleagues across healthcare to further increase the number of available organs and develop the infrastructure which is required to support this.

Since 2008, there have been major changes to the infrastructure around organ donation: with the embedding of clinical experts in organ donation within intensive care units; the establishment of clinical leads for organ donation from the intensive care community; and investment into publicity around organ donation. This has resulted in a significant increase in the number of organ donors across the UK.  As a result, waiting lists for transplants are falling for the first time in decades.

However, there is still work to do and organ transplantation and donation experts have written a vision for the UK – 'Transplant to 2020' – which aims to match world-class performance from other countries in organ donation and transplantation. The priorities identified in the vision are:

  1. To increase the number of people who have made their wishes about organ donation known
  2. To ensure that the public is informed and engaged about organ donation, making people proud to donate
  3. To ensure that excellent care is available to optimise the maximum number of organs for donation
  4. To maximise the life span of each and every organ transplanted, both by ensuring excellent support systems are in place nationally, and through ongoing research and development of novel techniques in organ preservation.

Currently, there is some debate about whether there should be legislative change, supporting ‘soft opt out’ in order to increase the number of organs available for transplantation. It is important that the debate is held and that it is thorough and well informed as, internationally, evidence to support this strategy is scanty. Countries in which the legislative change has been made without major investment into the infrastructure of organ donation, have not seen significant increases in organ donation rates.

In Scotland, media campaigns, for example those encouraging individuals to have a ‘wee chat’ with their loved ones about their wishes to become an organ donor, have led to increased numbers of individuals joining the organ donor register and should be supported. Work with peer educators focusing on ethnic groups, who traditionally have low rates of organ donation, is another key piece of ongoing activity which should be supported.

The debate is welcomed therefore, if for no other reason than it gets people talking about organ donation and, hopefully, signing up to the organ donor register and telling family members of their wishes to donate in the event of their death. Whether soft opt-out is ultimately effective in increasing organ donation numbers remains to be seen, and we await the outcome in Wales with interest.

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