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experts comment on the publication of the Taskforce on Presumed Consent

The UK Organ Donation Taskforce was asked by government to review the evidence for moving to a system of ‘presumed consent’, whereby all indivuduals would be automatically presumed to have given consent to organ donation unless they specifically opted out. The Taskforce reached the conclusion that the evidence does not support this move at the present time.

Dr Peter Rowe, Consultant Nephrologist, Derriford Hospital, said:

“I don’t think that basing the conclusion on a rather mechanistic analysis of data from other countries really addresses the issues, and the comments this morning from Elizabeth Buggins do not give real ethical counter argument to my mind. Presumed consent does not detract from gifting – it just supports the default position of wishing to give.

“The issue of trust in the medical profession is more difficult – and this needs education – but I don’t see why a decision made by government after wide consultation should detract from this. The Human Tissue Act has resulted in the position of placing a heavy reliance on appropriate consent (which is a good thing) but then places the relatives in a difficult position at the time of request if the deceased wishes are not known.

“There are two main obstacles to increasing donation and only one is addressed by the measures suggested (which I support) – that is the number of identified donors. The other is the consent rate – which I think may be actually decreasing – no good having lots of identified donors if consent for donation is not available.”

John Black, President of the Royal College of Surgeons, said:

“While much of the debate on donation has focused on the complex issues surrounding presumed consent, what eventually matters is that more people on the transplant waiting list get quicker, effective, life-saving transplants using the best techniques. We have to look at every way to improve donation rate and it is the duty of the Royal College of Surgeons to ensure the generosity and aspirations of donors are met by providing our surgeons with the skills to make every donation count.”

John Forsythe, Chair of Scottish Transplant Group and immediate Past President of the British Transplantation Society, said:

“For some time people have argued about whether the introduction of opting out legislation will change the donor organ availability in the UK. It is very interesting that Rafael Matesanz (the architect of the major changes in Spain) does not feel that the legislative change will make a major difference. Rather he feels that the way in which organ donation services are organised is much more important.

“Therefore I feel strongly that the Organ Donation Task Force first report which recommends 14 major changes in the infrastructure of organ donation and transplantation is the document which will produce most change. The recommendations suggest alterations which are much less “headline grabbing” and less glamorous. However they represent, in my view, the “hard miles” of change which will ultimately improve the numbers of organs available for transplantation and help the many thousands of patients who are on the waiting list at present.”

Prof David Albert Jones, Director of the Centre for Bioethics & Emerging Technologies,, said:

“I think that the Task Force has been very wise in resisting the calls for presumed consent. You can have ‘organ transplantation’ without consent, but it would not be ‘organ donation’. Donation means voluntary giving. If organ transplantation ceased to be free donation then people may well become suspicious of the intentions of doctors. The way forward in organ donation is to build on the support of the public and make it more effective. I think that presuming consent would endanger that support.”

Dr Chris Willmott, Senior Lecturer and National Teaching Fellow, University of Leicester, said:

“This sensible approach to presumed consent, following lengthy consultation, is in stark contrast to the recent inclusion of presumed consent in the legislation on production of admixed embryos, which was included at a late stage and without any public consultation.”

Adrian McNeil, Chief Executive of the Human Tissue Authority, said:

“This report has been eagerly awaited because we have not had enough information about the way an ‘opt out’ system would impact on the UK. For the first time we have evidence that informs the direction the UK should take.

“This impressive report adds even more weight to the key recommendation of the first report from the Organ Donation Taskforce that more resources need to be put into the current system to improve infrastructure and increase awareness of the Organ Donor Register.

“Now that the Taskforce has concluded that a change to an opt-out system is not desirable, the HTA will continue to ensure that the consent provisions of the Human Tissue Act are implemented.”

Shirley Harrison, Chair of the Human Tissue Authority and member of the Organ Donation Taskforce, said:

“There is clearly an urgent need to improve the quality of life and life chances of the thousands of people in need of transplants every year. The Taskforce’s first report made a series of recommendations that could increase the number of available organs by 50%, and the Government is actively taking these forward.

“The Taskforce was subsequently asked to consider whether a change to an opt-out system would increase the number of organs available for transplantation. Evidence-based policy making is essential in healthcare. The Taskforce was able to commission new research, bring together the best existing evidence from all over the world and to look long and hard at the legal, practical, cultural and ethical implications of a change.

“Under the present legislation, the Human Tissue Authority’s Codes of Practice make clear that consent is a positive rather than a passive process. This safeguard enables the public to have trust and confidence in the system. The evidence from this report shows that changing from the present system of active consent to an opt-out system would not increase numbers of organs available; and that there is potential for making the current low level of organ donation even worse by eroding the public’s confidence.

“The HTA believe that the Taskforce has carried out a very thorough investigation into opt-out; and commends the government for giving the Taskforce the time and resources to undertake a thorough piece of work before making a decision on future strategy.”

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