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Transplantation – Opting-in or opting- out for organ and tissue donation? May 2015

image Published: May 26, 2015

The Church of Scotland, along with many other faith groups, encourages organ and tissue donation. Currently in Scotland the system for organ and tissue donation involves an active “opt-in”, requiring a person to sign up to the organ donation register. An alternative “opt-out” model soon to be introduced in Wales means that an individual's organs are presumed to available for transplantation unless they have indicated otherwise.

Some may argue that an “opt- out” system represents state intervention and control over our bodies, while others may say that it would be immoral not to do everything possible to increase the number of organs available for transplant.

The current system is effective: 90% of deaths which meet transplant criteria and where the person registered as a donor during life results in organ donation. A person can have discussed with their family their decision to help others by allowing their organs to be used to prolong or greatly improve the quality of life of others. This can allow grieving relatives to reflect that, in the midst of distress, others have been helped.

In an opt-out system, the concept of a gift or of donation could be lost. There must be a balance, whereby any benefit of increased numbers of organs for transplantation justifies the loss of the concept of gift.

There are examples where an opt- out policy has had detrimental effects on the number of organs retrieved for transplantation; for example, in Brazil, body-snatching accusations meant the law had to be repealed.

People with less family support may find it harder to make their wishes known to those who may be consulted about organ donation. Some may not have the education, capacity or social circumstances needed to allow them to engage with health or legal organisations responsible for compiling the opt out register. Those with learning difficulties, homeless people or mentally ill people are among groups who may be, or may perceive themselves to be, less able to opt out.

At present there is broad public support for the organ donation system. An opt-out system may lead to cases where bereaved family later resent the taking of organs and complain that their wishes were not considered, or that they were pressurised into agreeing. Sensationalised reporting of such cases could result in the organ transplant programme losing public support. Bereaved families may feel unable to refuse donation in the absence of an opt-out order by the deceased, and may thus feel removed from the decision- making process. This could lead to distress and loss of trust, harmful to the bereaved and to medical teams alike.

Discussions of end of life issues at a time when death is not imminent can naturally include questions around organ donation and could be both helpful and comforting to relatives after a death. A paper discussing these issues in more depth was presented to the Church of Scotland General Assembly in May 2015; this can be found here.

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