Opt in or opt out - how to meet the needs for organ transplants
Organ donation is always an interesting discussion because it is one of those things that most people, if you were to ask them, do not seem to have an issue with and are generally very supportive of in the UK. And yet we have one of the lowest rates of organ donation in Europe. Why is this? To start to discuss these points, the first thing you need is someone who knows a thing or two about organ donation and the second is a suitable environment for honest and open discussion - welcome to the Birmingham Café Scientifique.
At the start of September, we were joined by Mr Hynek Mergental, a liver transplant surgeon. Hynek comes from the Czech Republic, where they have an opt-out system for organ donation, and apparently they also have a much higher rate of donation than we do here.
The interesting point with this is that it doesn't matter which country you live in, the process is the same. Forgive my bluntness at this point, but I want to be deliberately impersonal so as to make sure that my point is as clear as possible. In the most simplistic of terms, organ donation goes along the lines of the following: 1) a person dies, 2) their family/ next of kin are asked if they would like to donate, 3) a decision is made, 4) the organs are either recovered for donation or they are not. Whether a country has an opt-in or opt-out policy on organ donation, doesn't really make much of a difference in this process, but what is important, is the perspective of the family or next of kin. In the Czech Republic, where Hynek comes from and everyone grows up knowing that you opt-out if you don't want to donate, it is presumed that you wish to donate your organs unless you state otherwise and opt-out. This does not mean that teams of malicious surgeons are racing around looking to 'steal' organs from the recently dead or soon-to-be dead, without their families consent. Rather it means that if you unfortunate enough to be in that situation where you are asked if a loved one wanted to donate, you can go from the position of - "well I guess they must have or else they would have opted out". The families still have the right to decline donation if they wish, and conversely, even if the person has opted out, they can still choose to donate their organs.
Compare this to an opt-in system such as we have in the UK and again, imagine you are unfortunate enough to be in that situation. Unless you have had that specific conversation with your family about their wishes, you cannot really know how they feel. If you are asked that question, how could you know what they feel? They might have signed the organ donation register and maybe even carry a donor card, but if it is that important to them, would they not have mentioned it? What if they haven't signed up, what then? You might believe in organ donation, but what if your mother/ father/ brother/ sister/ son/ daughter didn't? Are you going to allow their body to be used for donation when perhaps they didn't want that? Will that be your last action for this special person in your life?
And this is the fundamental difference in the two policies; it is a matter of the starting point. In the UK, we assume that no-one wants to donate unless they choose to opt in, whilst in many other countries (including the Czech Republic) it is assumed that you want to donate unless you say otherwise. As I have already mentioned, the families are always consulted regardless of the system, but the families have a better idea of how individuals might feel in an opt-out system.
One thing is absolutely clear however and that is regardless of where you live or what your country's policy is, the most important thing that you can do with respect to organ donation is to talk to your family and in particular, your next of kin, whoever that may be. They are the person who will ultimately make that decision and it is they who will carry out that responsibility on your behalf when you are no longer able to speak for yourself. In the UK, the second most important thing that you can do is to sign up to the organ donation register. At least then, if the decision does need to be made and you have not had the chance to make them aware of your views, at least there is a suggestion of how you feel. They can of course still veto it, but that is for them to live with afterwards; probably best to sign up and tell your family!
Interestingly, we were having these discussions with Hynek, in the Jekyll and Hyde Pub, and he was surrounded by a roomful of people boozing away (me at least) whilst he enjoyed his soft drinks. It says something when a liver transplant surgeon tells you that one quarter of liver transplants are to overcome years of alcohol abuse and he is drinking soft drinks whilst telling you this. Mind you, when the first transplants were carried out, surviving 24 hours was considered a success. Nowadays, 50% of transplant recipients survive 5 years or longer!