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Wales considers "opt-out" Organ Donation scheme


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Welsh government's 'opt out' organ donor consultation



Families would have no legal right to stop dead relatives' organs being used for transplant if the person has not opted out in advance, under a proposed Welsh law.


However, Health Minister Lesley Griffiths said she could not see a situation where doctors took organs without the permission of families.


Ministers are asking for views on plans for a "soft opt-out".


If it goes ahead, Wales would be the UK's first country with the system.


Ms Griffiths said the lack of organs and tissues caused unnecessary deaths and suffering.


The law, planned to be in place by 2015, would require people to opt out of donating their organs when they die, rather than opting in by signing the register.


Doctors' leaders hope it will "change cultural expectations" and prompt more family discussions about donation.


At the moment the wishes of the deceased are given priority.


If someone is on the organ register their families cannot refuse for their organs to be donated.


But if the family object and a dead relative has not asked for organs to be donated, then organs will not be used.


Under the Welsh government's proposals people will be considered to have made an "expressed view" that they want their organs to be donated, unless they opt out.


There will not be a family veto against allowing organs to be used.


However, the health minister told BBC Wales she did not think that the proposals would mean families losing the ability to refuse the organs of loved ones being donated for transplant after they die.


She said, in practice, she "could not see a situation where clinicians take the organs of a donor without the permission of families".


First Minister Carwyn Jones will unveil the plans at the transplant unit at the University Hospital of Wales, Cardiff, on Tuesday morning.


The system is designed to increase the number of organ and tissue donors, if legislation is approved.


The Welsh government's white paper sets out proposals for how the system would work:


Only people aged 18 or over who both live and die in Wales would be included under the system

People must have lived in Wales for a sufficient period of time before being included in the opt-out system - the white paper invites views on how long that period should be


It proposes four options for how people's wishes on donation could be recorded - a register for Wales of persons who have not objected, and a register of persons who have objected; a register for Wales of only those persons who have not objected; a register for Wales of only those people who have objected; no registers but a record of objection given to and held by GPs.


Ms Griffiths said the Welsh government believed the legislation would go a long way to increasing the number of organs and tissues available.


"When people die, donation of their organs and tissues is often possible but currently does not happen - not because they did not wish to donate but because they never got round to joining the organ donor register," she said.


"Repeated surveys show that the overwhelming majority of people in the UK and Wales believe in organ donation, but only one in three people in Wales have joined the organ donor register.


"Last year 67% of donors were not on the organ donor register. Therefore we believe creating an environment in which donation is the norm will enable more organs to be available."


The minister added: "Introducing a soft opt-out system will mean people are more likely to make decisions about donation during their lifetime and to have discussed their wishes with their family."


The British Heart Foundation called for the UK's other governments to follow Wales' lead, saying an opt-out system would prove to be the difference between life and death for many families.


"Wales has taken a substantial and significant step towards implementing a proven system that will see more heart patients receive the organs they need to stay alive," said Maura Gillespie, the foundation's policy and advocacy manager.


"An opt-out system would better reflect the wishes of the majority of people, and fill the void between good intention and action."


Roy J Thomas, chairman of Kidney Wales Foundation, described the government's plan as "a progressive move by Wales".


"The UK has one of the lowest donor rates in Europe," he said. "Wales will take the lead and show that we must presume to have conversations on this important issue."


Mr Thomas said presumed consent in itself was not the solution but rather a key facilitator within a well developed system and infrastructure for organ donation and transplantation.


"There has already been a significant increase in the number of donors in Wales to 66 in 2010/11 and the people of Wales understand this debate," he said.


Dr Tony Calland, chairman of the BMA's medical ethics committee, said it fully supported the move.


"The fact is that every year people die whilst waiting for organs, and evidence from other countries has shown that an opt-out system can address the shortage of organ donors and can save lives.


"We hope that a move to a soft opt-out system would change cultural expectations in society, and prompt more discussion within families about organ donation," he said.


But Glyn Davies, Conservative MP for Montgomeryshire, said he would be seeking time in Westminster to debate the issue.


Mr Davies said presumed consent would only deliver "a fraction more organs".


"One of the real problems I've got with presumed consent is that it undermines trust," he said.


"I don't mind moving towards a presumptive attitude because almost everybody is in favour of organ donation so it's reasonable to have a presumptive attitude.


"But if there's presumed consent, then there's a suspicion and I think that does affect trust."


Consultation on the proposals outlined in the white paper and closes on 31 January 2012.


The Welsh government said a bill would be introduced in 2012. Legislation could be in place by 2013 and a soft opt-out system could come into effect in 2015.


Transplant activity in Wales 2010/2011


There was a 60% increase in the number of deceased donors to 66 (in Welsh hospitals).


The number of donors after brain death increased by 45% to 39 and after circulatory death by 90% to 27.


There was an increase in the Welsh consent rate after brain death from 59% to 66% and after circulatory death from 28% to 62%.


The number of patients registered for a transplant fell slightly to 306 were waiting at the end of March 2011 and 122 had been temporarily suspended. 49 died waiting.


Nearly 200 patients received treatment.


Source: Kidney Wales Foundation


So, your views please. To me this is one of the best ideas ever, I think unless you are against it then why shouldn't your organs that you no longer need potentially go to help someone else. I'd like to remind those of an Anti-opt-out persuasion that the consultation still recommends that family have the last say so if they choose to they can still veto the donation but that it will imply that if you did not say "no" then you were happy for organ donation to be possible with your organs.

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As I said last year when we discussed this


The biggest reason for an opt out rather than an opt in is lazyness. People who dont want to do it but are lazy are more likely to get off their arses and to opt out than people who are too lazy to opt in. If you get me.



So yeah, good thing as far as I am concerned.

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On one side I see the benefit, on the other I am wondering if the world needs more people surviving with the death rate being outstripped by the birth rate and if this will open up dubious practice and an organ black market.
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There really isn't a downside to an opt out system. The organ black market already exists and is worth a fortune... if anything, a plethora of new legitimate donors is probably going to hurt the black market. And the idea that doctors might let patients die to harvest their organs is, at best, unlikely. Doctors are pledged, first and foremost, to do their utmost to save the life of the patient in front of them. And if they can't, then at least that patient might help save someone else. Yeah, there might be bad apples who might take money to ensure a patient dies so their organs can be harvested and go to someone rich... but 1) they're already in the barrel and 2) if it's a legal harvest, the organs are allocated via the legitimate transplant register.
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I can only see this as a good thing. So many times I've heard people say "yeah transplants a good idea, no I'm not on the list yet as I haven't got round to it". The opt-out system would much better combat this.


Saz, I can sort of understand where you're coming from, but can't bring myself to agree with it. Having many friends have a transplant, die waiting for a transplant, and a few waiting for their call I can only see it as something good. I have 2 friends who go to the same hospital as me, both a year younger. One is on the list, one being assessed for the list both needing new lungs. One has managed to have a bit more of a life than the other, one has never known a lung function over 60% her whole life and is currently at between 15 and 20% function of her lungs. I would want to do anything to save them and help them live a better life and hopefully a more normal life expectancy. At the moment their lives revolve around the hospital and that just isn't fair. Transplant can change that so for that reason I'm all for it.


I was reading this story this morning - http://www.dailymail.co.uk/health/article-1299589/Woman-ALL-major-organs-transplanted--qualifies-doctor.html

It just amazes me what a transplant can help someone achieve.

Edited by Gemsi
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Oh, don't get me wrong, I understand totally that it's human nature to want to survive, but that nature is also leading to a population explosion because of our other human nature to breed.


It's not like I'm going to go out and protest vigorously, but part of me does question if bodyshopping dead people isn't furthering overpopulation and a strain on our health system already.


Now, I am more than willing to say that I'd probably be singing a different tune if I was in need of a transplant, as my need to survive would kick in, but I'm not. I hope my views (or perhaps concerns) will be enough to engage a conversation. :)

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Well who'd have thought you'd need to debate something on a discussion forum, what a concept. :P


Just to prove it's a debate and not simply a mick take, when you say that this system would put a strain on the NHS surely we're talking about curing people who would otherwise be a continual drain on the NHS requiring things like dialysis or concstant/regular hospital stays to keep them alive whilst they wait for a transplant? I mean having more healthy/cured people has to be less of a strain on the NHS than dealing with long term illness?

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Maybe it's paranoid, but my only issue with this is that it could be used as an excuse by some not-so nice doctors to harvest organs. Allow me to explain.....


Imagine the scenario: You've just been in a terrible accident. You are unable to move or speak, but you are concious enough to hear what everyone is saying around you. Your family enters the room. The doctors say that there is no hope for survival. Once your family leaves, you hear this from the doctors:


Doctor 1: You do realise that he will make a full recovery with treatment right?


Doctor 2: I know. But he's listed as an organ donor - we need the organs.


Doctor 1: So you lie to the families?


Doctor 2: That's right. Keep quiet.


The doctors leave, and you are yelling inside, unable to stop what they are doing. They come back later - dosing you with anaesthetic, your family looking on, all whilst you know the truth - but aren't able to let anyone know.....


Now that's a nightmare scenario for me.


In other words, and to cut a long story short, my only issue with it is that it could be that some patients could be purposely left untreated so that they can harvest the organs. And I don't mean untreatable/dying patients either, I mean patients that would otherwise make full-recoveries if the effort to treat them was there.


Of course, you could say that my worry is ridiculous.....but still.

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The argument against that is that the doctor "harvesting" the organs has no say in where they go or know that the organs will be a match for someone. As Jimmy said they'd essentially be killing someone (which they take on oath against) with absolutely no guarantees the death would benefit anyone, least of all anyone they might know who needs a transplant.


Plus, and I make the point again, the family still has the last say under these proposals so even if the person didn't choose to opt-out the family can still say no. The only change is that currently the implication is that if you aren't a registered organ donor then you don't want to donate so if you never told your family what you really want then the presumption is against donation. The new scheme makes the opposite assumption but in both scenarios the family still retains the right to the final decision.

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That's why they do checks on organs before transplanting them Max, before even transporting them. I know they will be able to take some of my organs, but which ones they will have to decided at the time as my kidneys might not be fit enough after years of industrial strength antibiotics, but otherwise don't carry the CF protein problem. It used to be common practice to transplant CF hearts as even though enlarged they are used to compensating for the lungs and therefore are really storng. Not sure if this is the case anymore. It depends on the condition of everything at the time. It's always worth beign on the donor register just so they know you agree to it, they can make the decison at the time if there's actually anything of use.


There was a program on called Transplant a few weeks ago. It was very informative with who made decisions on where organs went to etc. Full medical teams are more in charge of patients now, nurses have a lot more knowledge and things aren't just left to doctors anymore. Any anaesthetic has to be prescribed by an anaethenatist and brought from pharmacy (nothing of value is stored on the wards anymore) with them double checking stuff, it is then administered by a nurse, doctors see themselves above doing such mundane tasks as giving medication, I would be suspicious of any doctor who didn't. More than 1 person would be making the decision if a person is going to make it or not, there has to be an MDT (Multi-Disciplinary Team) meeting about anything like that. Plus tests would have to be carried out before any final decisions are made, there is a certain procedure that has to be followed through now, lots of paper work, and if they get it wrong then it's their necks on the line.


There is a team of medical staff who take the organs, all from different transplant centres of where the expected organs are going to be sent, not just from the hospital the patient has died at. The organs are checked out after the patient has died it is then decided which transplant centre the organs will go too, this is decided by the transplant coordinator. Not all those medical staff are likely to be corrupt. Even with presumed consent for organ donation it's not going to change the system much from what it is now except it's more likely going to get people talking about their wishes with their families which can only be a good thing.

Edited by Gemsi
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