Your own death is not something that most people like to prepare for in advance. What happens after life ends is debatable, but whatever your beliefs, one thing that most of us agree on is that after our death, we no longer have a use for our bodies or the organs that lie within them.

NHS studies estimate that up to 90% of UK people agree in principle with organ donation, but only about 25% of the population are actually registered as organ donors. This may seem like a high proportion – the number of registered donors has doubled since 2001, thanks to drives by the NHS – but in reality, many more still need to sign up to meet the constant requirement for donor organs. On average, an estimated 1000 patients on the transplant list die every year while waiting.

Although organ donation has the potential to help many, there are several reasons why people do not register themselves as donors. Some perceive the process of registration to be too complicated and time consuming, while others believe they are too old to register, even though there has been successful tissue transplants from people in their 70s and 80s. A common occurrence is that people just simply forget. It is easy, when you lead a busy lifestyle, to keep putting things off until later, especially if you perceive the chance of becoming a donor to be slim.

The current system in place in the UK is one of ‘opting-in’, whereby people actively have to choose to be organ donors. If this decision is not made during a person’s lifetime, it is the responsibility of their partner or their immediate family to make the decision on their behalf. One of the major problems with the family making a proxy decision for the use of their relative’s organs is that it may not be in line with their loved one’s wishes and could even go actively against them, especially if these were not explicitly stated during their lifetime.

Another point to bear in mind is that the decision has to be made at a time that is very emotionally charged for the family. Having to decide the fate of their relative’s organs at a time of mourning may not be conducive to making the choice to release the organs for the people awaiting a transplant. The NHS estimated in 2008 that 40% of possible organ donations were refused by the donor’s family.
The constant need for donor organs has required reviews of the current system to try and address the deficit in organ supply. The principal alternative is a system of presumed consent, in which individuals would be required to ‘opt-out’ if they did not wish their organs to be transplanted when they died. If this wish were not registered, then it would be automatically assumed that the person wished to donate. There are a few countries with this system, most notably Spain, where it has been credited with helping to give the country much higher rates of organ donations as well as special donation teams that speak with the family about their relative’s wishes while they are still in a ventilator-maintained state.

It would seem, from the Spanish model, that this could be successful in the UK. However, there are arguments against presumed consent. One is that Sweden, which has a similar model, has a lower rate of organ donation than not only Spain, but also the UK. Also, Spain has a higher rate of road traffic accidents than the UK, which greatly contributes to the number of available organs for donation. It would seem that a simple system of presumed consent might not hold all of the answers for increasing donor registration.
Following an investigation and discussion in 2008 by an NHS taskforce dedicated to organ transplantation issues and a possible opt-out system, it was recommended that the UK retain an opt-in system, which is still in place today. This was partly due to a belief that an opt-out system may lead to the erosion of patient trust in the NHS and possible complications and controversy. Today, the NHS continues to try and increase the number of people registering as organ donors, with targets set at another 9 million registering by 2013. This year also sees a £4.5 million government-supported campaign to increase public awareness of organ donation.

Why should you donate? Your organs may help to sustain a life, even after your own has ended. Registering as an organ donor is one of the most generous decisions that you can make; you will be giving the chance of a healthier life to others, a life that could also be longer than the one they could expect without the transplant. Is it morally acceptable to waste what could be used to help so many when you no longer require it?

Jack Bennett

To register as an organ donor and for more information, visit: www.organdonation.nhs.uk/ukt/

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