Through the years organ donation has always been a sensitive topic from religious, ethical and philosophical viewpoints, views vary on whether organ donation provided more benefit than risk. In England from May 2020, the rules around organ donation have placed England into an opt-out system meaning that those who are over eighteen, not in an excluded group (like those who do not have the mental capacity to consent) and have not opted out from having an organ donation are all presumed to give consent for donating their organs, (NHS Organ Donation, 2019). This system provides similarity in the opt-out procedures within Scotland and Wales as well, but let's dig deeper to understand truly both the advantages and disadvantages regarding organ donation to self-evaluate whether going forward with an organ donation is the right way forward.
Firstly, let this sink in “Every day across the UK, someone dies waiting for an organ transplant”, (NHS Organ Donation, 2019), (www.youtube.com, 2019). Or how about “More than a third of the people requiring transplants are from black and ethnic minority communities, there are not enough organs on the list for them”, (www.youtube.com, 2019). Alongside how more than 5,500 people in the UK need a transplant, but a shortage of donors means that around 3,500 transplants are carried out annually, (Power, 2011). With the shortage and understanding of human life at risk going forward, it is advantageous organ donations provide stability and support for those who need it most.
In the case of Max, who is a young child and plays a significant role in the change of legislation regarding the opt-out organ donation system. Max's cases involved a diagnosis of an enlarged heart, placing Max on the urgent heart transplant list, in which Max saw many tragedies around him. These include seeing children in his medical ward lose their lives due to a lack of transplants. The Mirror newspaper contacted Max for the “change the law for life campaign” and through the House of Commons and House of Lords, the campaign helped to implement legislation thanks to Max's efforts in the campaign too. Max's story, one of crucial importance in highlighting awareness and the importance of organ donation concerning the medical pillars of ethics of "doing no harm" to patients. While also providing that medical justice to ethically benefit the health of the public in the new opt-out system which seems to both satisfy medical ethical guidelines while doing patients justice, (www.youtube.com, n.d.).
In the UK even within the Covid pandemic researchers were able to find transplant activity was down to around 80% of normal levels, with 3,391 transplants carried out in the UK compared with 4,761 in the previous 12 months, (the Guardian, 2021). Through the pandemic, there has been an immense strain on the NHS from the increase in waiting lists to the postponing of important but non-vital organ donations which have even led to some living donors, unfortunately, passing away. Understanding that organ donation is something most people would in terms of it rarely receive but can actively play a part in saving the life of fellow human beings, which can be seen as a major form of compassion and charity. Advances in medical science also mean that the number of people whose lives could be saved by a transplant is rising more rapidly than the number of willing donors., (Power, 2011). As a compassionate, benevolent and understanding society, would it not be in our best interests to help our unwell patients?
On the other hand, it is fascinating learning on the other side to why organ donation may be more harmful than beneficial. The argument against organ donation can be seen to come from a safeguarding and personal privacy viewpoint. These arguments advocate that the change to an opt-out system is open to abuse, with the possibility of potentially speeding up to secure an organ for a patient. There are also talks that the inadequate safeguard to deny being an organ donor can be seen as crumbling away for the fear families and individuals who do not want to donate may be seen as selfish and this could negatively affect their decision-making for this complex and sensitive topic, (Power, 2011). Along with the analogy from a limited government perspective that the state should not automatically have access to our bodies and that our individuality should triumph over the growing powers of the state, (Power, 2011). The risk with organ donation can be the issue that major ethical flaws can occur and the issue that various opt out organ donation systems take away decision-making from patient-centered care and move in the interest of the government.
In addition to organ donation, understanding that the opt-out system itself has flaws is a vital talking point when considering the risk-benefit analysis to patients. Rosy Edwards, a kidney patient who you would not expect would oppose the new opt-in organ donation system as she is someone who has had two kidney transplants from families and donors. Edward's words explain that “our beloved yet beleaguered NHS cannot support the type of infrastructure needed to facilitate more transplants”, (Why I oppose opt-out organ donation despite needing a kidney | ITV News, 2018). Edwards also references Wales having a soft opt-out system talking about how little convincing evidence has emerged to support an increase in transplants rates as 1 in 20 people excluded themselves from organ donation in the introduction of the opt-out system, (Why I oppose opt-out organ donation despite needing a kidney | ITV News, 2018). The risk seems to be that an opt-out system does not do organ donation justice in recognizing individual patient beliefs, the cost-benefit analysis due to the scarcity and demand of resources in the NHS and the pragmatism to ensure an overall effective organ donation of mass public benefit are among some vital factors to also consider.
Organ donation from the recent law changes to the principles at large is a concept that differs from individual to individual for the variety of opinions present. What is important to know is that no matter what your opinion is, organ donation is one aspect of medical ethics that as medical technologies continue to grow organ donation may become more of a frequent talking point than we guessed.
References:
1. NHS Organ Donation. (2019). Organ donation law in England. [online] Available at: https://www.organdonation.nhs.uk/uk-laws/organ-donation-law-in-england/.
2. www.youtube.com. (n.d.). Muslim medical professionals discuss organ donation. [online] Available at: https://www.youtube.com/watch?v=EbPh8s6HV0I [Accessed 2 Sep. 2021].
3. the Guardian. (2021). Huge decrease in organ transplants as Covid took hold across world. [online] Available at: https://www.theguardian.com/society/2021/aug/30/huge-decrease-in-organ-transplants-as-covid-took-hold-across-world [Accessed 2 Sep. 2021].
4. Power, G. (2011). Opt-out organ donation: pros and cons. [online] The Week UK. Available at: https://www.theweek.co.uk/35635/automatic-organ-donation-the-pros-and-cons.
5. Why I oppose opt-out organ donation despite needing a kidney | ITV News. (2018). YouTube. Available at: https://www.youtube.com/watch?v=vhqp54dLxMs.
6. www.youtube.com. (n.d.). The Boy Who Helped Change the Organ Donation Law | This Morning. [online] Available at: https://www.youtube.com/watch?v=5hwNoDZeX20 [Accessed 2 Sep. 2021].