Opt-out organ donation will save lives say physicians

The Royal College of Physicians of Edinburgh (RCPE) has said that a proposal to introduce an opt-out system for organ donation in Scotland could lead to “increased rates of deceased organ donation”.

Glasgow Labour MSP Anne McTaggart has lodged her Transplantation (Authorisation of Removal of Organs) Scotland Bill at Holyrood, which proposes to introduce a soft opt-out system where everyone would be considered a donor by default.

The current system requires people to join the NHS Organ Donation Register.

Under the new system, the family of the deceased will be asked if they had expressed any objections to donation during their lifetime.

The college said the proposed shake-up would “make a small but real difference to the number of organs donated in Scotland”.

It made the remarks in a submission to the Scottish Parliament health committee’s scrutiny of the Transplantation Bill.

MSPs will hear from RCPE, the British Medical Association (BMA) Scotland, the British Heart Foundation (BHF) and the Scottish Youth Parliament (SYP) on the issue today. The college said: “Some Fellows have expressed the view that there are a number of individuals who would be donors but have not made that view known before their death.

“The move to a soft opt-out system would therefore likely make a small but real difference to the number of organs donated in Scotland. The available international evidence supports the fact that ‘opt-out’ legislation is associated with increased rates of deceased organ donation.”

However, the college expressed some reservations about the bill and said that the “immediate family should always be consulted about the request to harvest organs and asked about the expressed wishes of the deceased”.

But the BMA said that Scotland must shatter “the myth” that organ donation should be regarded as “a gift” - and said the proposal to nominate a proxy seems complicated when people can just give prior authorisation when they are alive.

The SYP said the proxy is particularly important for young people in care, whose decision-making capacity may be questioned but who may object to blood relatives making decisions on their behalf.

A Scottish Government spokeswoman said: “In Scotland we’ve delivered a number of measures to increase donation. Since 2008 we have seen an 82 per cent increase in the number of deceased organ donors in Scotland; a 42 per cent increase in the number of transplants undertaken; and a 21 per cent reduction in the active transplant waiting list. 42 per cent of Scots are signed up to the NHS Organ Donor Register – the highest percentage of any of the four UK countries.

“We’re supportive of measures to increase organ availability, but sadly this specific piece of draft legislation is seriously flawed and could actually harm organ donation.

“However, while we are very concerned about the design of this particular draft legislation, we’re taking an evidence-based approach to the specific issue of a soft opt-out approach to organ donation. We will be monitoring the implementation of this in Wales, to see what impact it has on organ donation and transplant numbers, and whether any increase could be replicated in Scotland.

“We have a number of concerns about many of the measures set out in the member’s Bill, which could create significant legal and operational issues. For example, the proposition that adults with incapacity would be unable to legally express an objection to the donation of their organs is deeply troubling. There are also concerns about the use of proxies, the introduction of the concept of Authorised Investigating Persons.”