A proposed European Commission directive on organ donation must be flexible enough to allow for clinical judgment and for patients to be able to make an informed choice, a report by the House of Lords European Union Committee says.
The report, while supporting the European Commission’s proposal to introduce a directive on the quality and safety of organ donation and transplantation, says that the commission must not impose requirements beyond those that are clinically justifiable.
It comes down against the idea of presumed consent, under which everyone is considered to have consented to their organs being used after death unless they have opted out of the scheme by signing a register. Such a system already exists in Spain, where it has been credited with greatly increasing the number of available organs.
The report says: “Clinicians and patients together must have the freedom to make informed decisions about the balance between the acceptability of organs to be transplanted and the medical needs of the patients.”
The report further points out that the clinical criteria for judging the acceptable quality of an organ destined for a patient who urgently needs a transplant to avoid imminent death will be different from those used in judging an organ for a patient who can afford to wait longer.
Describing the opt-out system of organ donation as “premature” for the United Kingdom, the report says: “The system of presumed consent would be ineffective without the numbers of skilled staff and coordinated system needed to deal with the greater volume of donor organs this might generate.”
It proposes reorganisation of organ donation services as the key to improving the UK’s organ donation rate, which, the report says, lags “substantially” behind the best performing countries in the European Union and the overall EU average. The rate of organs donated in the UK is 12.8 per million, while the European average is 18.8. Spain leads the EU in organ donation with a rate of 35.1 per million.
“We must do much more to emulate successful schemes such as that in Spain,” said the subcommittee’s chairwoman, the cross bencher Valerie Howarth.
Baroness Howarth added, “All parts of the NHS must accept organ donation as a usual—not an unusual—event and [must accept] that many more, and better trained, medical staff should have the role of providing organ donation services.”
Commenting on the report, Tony Calland, chairman of the BMA’s medical ethics committee, described the UK’s organ donation figures as “disappointing.”
He suggested a “two pronged strategy” to increase organ donation. “On one level, systems and structures need to be vastly improved,” he said. “At the same time we need to create an environment in which a move to a system of presumed consent with safeguards eventually could work.”
The charity Patient Concern said it was “delighted” that the report had backed its views on presumed consent. “The government should spread the word on organ donation effectively rather than using presumed consent as one of their regular eye catching initiatives and pretending that it will be a cheap quick fix,” said Joyce Robins, the group’s codirector.
The European Commission plans to publish its proposals on the quality and safety of organ donation and transplantation by the end of 2008.
Increasing the Supply of Donor Organs within the European Union is available at www.parliament.uk/parliamentary_committees/leuscommg.cfm.
Cite this as: BMJ 2008;337:a698