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The situation in the U.K
UK residents have to make their wishes known by telling their family
In the UK it isn't automatically assumed that everyone wants to be a donor after their death. UK residents have to make their wishes known by telling their family, submitting their details to join the NHS Organ Donor Register or carrying a donor card. This is known as opting in. If a person dies, whether they've registered or not, their relatives are then asked for their agreement before organs are removed.
However, there's been a lot of discussion recently about whether the UK should have an opt-out system, whereby everyone is considered to be a potential donor unless they've specifically said they don't want to donate.
So, what are the key issues around the opt-out system and how do other countries compare?
Public opinion in the UK is shifting
Public opinion in the UK is shifting and this could result in a change in the law governing organ donation. A BBC poll carried out in May 2005 found that 61 per cent of those questioned supported a change to an opt-out system.
This is a large increase compared with 26 per cent in 1999 (in an unpublished survey by the Department of Health).
If the UK adopted an opt-out system, health professionals would be able to assume that everyone had agreed (or consented) to donating their organs unless they'd specifically opted out in writing.
This system, which is also known as presumed consent, is used in most other European countries. Those who support this system argue that it relieves relatives of being asked whether organs can be removed when they're going through a traumatic time.
However, others believe it can cause major distress to relatives who feel that they haven't been consulted. In a debate last year, the health minister, Rosie Winterton, set out the government's position saying: "Organ donation is a gift from an individual that helps to save the life of another individual. It is also a gift to society. We believe very strongly that we should not assume that someone wants to make that gift."
There's also concern that there could be medical risks involved with removing organs without discussing it with relatives, because there could be vital information about the person's previous health that may affect the recipients.
The British Medical Association (BMA) supports a change in the law to presumed consent. Some patient groups, transplant surgeons and the Liberal Democrat party all argue for a change in the law.
Most agree that the organ donor shortage is a serious issue. But while nearly 90 per cent of the UK population say they'd be willing to donate their organs after death, only about 20 per cent of people have actually put their names on the NHS Organ Donor Register.
So would an opt-out system help the shortage? A report in the journal Science in 2003 found that European countries with opt-out policies showed a 16.2 per cent increase in the number of donors.
A similar 1998 study in the medical journal The Lancet found that a shift to the opt-out system in Spain, Austria and Belgium had increased the number of donors in all three countries.
Other countries such as Australia, which has the lowest rate of organ donation in the Western world, are now considering a change in the law so if a person has registered their wish to donate through the Organ Donor Register, it's legally valid. The Australian government is sending every household an organ donation consent form to try and increase the numbers of those registering.
There are two types of opt-out system - either hard or soft.
Spain
The views of relatives are sought and they can refuse consent
Spain has the soft opt-out system, where even if the person hasn't themselves opted-out of donation, the views of relatives are sought and they can refuse consent. About 20 to 24 per cent of relatives refuse, compared with currently 40 per cent in the UK. Spain has a higher number of donors than the UK and has had a year-on-year increase in organ donations for the past ten years.
But the country also has a higher number of road deaths and a system where relatives of potential donors are always approached by specially trained staff. So even if the system was changed, the level of organ donation in the UK may not reach that of Spain.
The Director of the National Transplant organisation in Spain, Dr. Matesanz, says the lesson of the Spanish experience is that it makes a huge difference if you have a person responsible for identifying possible organ donors in hospitals, not whether you change the system to opt-out.
Austria
The number of kidney transplants performed was nearly equal to those on the waiting list
Sweden which also has a opt-out system actually has a lower rate of organ donation than the UK
However, an opt-out system does not necessarily mean there will be more organs available for donation. Sue Falvey, director of donor care and coordination at UK Transplant, points to the Swedish example, saying: "Sweden, which also has an opt-out system, actually has a lower rate of organ donation than the UK, suggesting that opt-out is not the sole factor in increasing organ donation."
A different policy operates in the US, which tries to ensure that relatives are always asked about the possibility of donation. This policy is called 'Required request' and is defined "that it shall be illegal as well as irresponsible to disconnect a ventilator from an individual who's declared dead following brain stem testing without first making proper enquiry as to the possibility of that individual's tissues and organs being used for the purposes of transplantation."
This policy means opportunities for donation aren't missed - as they can be in the UK.
The latest report from an on-going audit by UK Transplant carried out in 2003 to 2004 found that in 15 per cent of cases there was no record that the relatives had been approached to give their agreement to organ donation.
The introduction of required request in the US saw an initial increase in organ donation, but this has since declined.
