Organ donation debate

Behind the Headlines

Monday January 14 2008

Picture of a box of human organs for transplant

Changes to the system of organ donation are being proposed

A system that assumed everyone was willing to donate organs unless they explicity opted out ahead of their death could “close the aching gap between the potential benefits of transplant surgery and the limits imposed by our current system of consent”, wrote Gordon Brown, the prime minister, in The Sunday Telegraph yesterday. He called for a national debate on the issue. His comments come ahead of a report from the Organ Donation Taskforce to be published tomorrow. It is expected to recommend a series of important but less controversial reforms to the current system as an interim measure.


How does the current system work?

Organs for transplant are currently only taken from people who made a positive decision during their lifetime to become a donor by placing their name on the NHS Organ Donor Register. The register currently holds the names of nearly 15m people or 24% of the population. However, only a small proportion ever become donors. This is partly because of inefficencies in the organ matching system but mainly because they die in circumstances that mean their organs cannot be donated to others.


Do relatives currently have a say?

Yes, even where someone has placed their name on the Organ Donor Register, doctors must get their relatives’ permission before removing their organs. Chris Rudge, the director of UK Transplant, said that lack of family consent meant four out of 10 organs considered suitable for transplant were not being used. 

Are there many people waiting for organs?

Yes, UK Transplant estimates there are between 7,000 and 8,000 people currently waiting for a transplant in the UK, with about 3,000 transplant operations being performed each year. In 2006-07, according to UK Transplant, more than 400 people died while waiting for a transplant because of a shortage of suitable organs.


What organs can be donated?

Kidneys, heart, liver, lungs, pancreas and the small bowel can all be transplanted. There is also the possibility of tissue donation: corneas, skin, bone, tendons, cartilage and heart valves can all be used by doctors to help others.



What is the main change being proposed?

A switch from voluntary registration via the Organ Donor Register to a system of “presumed consent”. This would mean everyone would be regarded as a potential donor unless they had specifically registered an objection. The prime minister said this could “could increase donation levels significantly”.



Do other countries use this system?

Yes, “presumed consent” is used in many other European countries: in either a “soft” or “hard” form. The “soft” approach, used in Spain, allows relatives to refuse organ donation after a death. However, in Austria, the “hard” system means that the views of relatives aren’t considered after a death.



Would the UK go for a “hard” or “soft” presumed consent?

It is not clear. The prime minister said there should be a “genuine debate” about the whole issue of presumed consent. He has asked the Organ Donation Taskforce to begin a consultation with professionals the public. He added that for those under 16, the final decision would always be left with the family. “This is only right and proper” he said.


Are other changes being proposed?

The taskforce has made 14 recommendations for tackling transplant waiting lists. They include doubling the number of transplant coordinators in the NHS to 200. Coordinators identify possible donors, talk to bereaved families and inform the national transplant list. Dedicated organ retrieval teams available 24 hours a day would also be established to work closely with the critical care teams in hospital.

What can I do now?

Place your name on the Organ Donor Register today. It’s possible to register online at UK Transplant or by calling 0845 60 60 400 (24 hours a day). If you do decide to register for organ donation, make sure you inform your family and friends of your wishes. If you’re still unsure, watch the NHS Choices video on the benefits of organ donation. You can also find out about the history of transplants with our interactive transplant timeline


Is transplantation possible using living donors?

Yes. There have been an increasing number of organ donations by living donors. In particular, there has been an increase in kidney transplants, as people are able to live a normal life with just one kidney. It is also possible to donate a part of the liver, lung or, in rare cases, the small bowel. However, this type of transplant is not suitable for all organs and needs to be considered very carefully due to the risks to both donor and recipient.


Analysis by NHS Choices

Edited by NHS Choices

Links to the headlines

'Organ donations help us make a difference’. The Sunday Telegraph, January 13 2008

Further reading

British Transplantation Society. Guidelines relating to solid organ transplants from non-heart beating donors. November 2004 [PDF]

Royal College of Pathologists. Ethical issues in organ and tissue transplantation to humans. August 2005 [PDF]

NHS National Institute of Clinical Excellence. Living-donor liver transplantation. November 2006 [PDF]

Department of Health. Organs for transplants: a report from the Organ Donation Taskforce. January 2008


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