'Opt out' system could solve donor organ shortage, says researcher

October 31, 2008

A system of presumed consent for organ donation - where people have to opt out of donating their organs when they die - is the best way to tackle a growing waiting list for transplant.

That is the opinion of Dr John Troyer, an expert in organ donation and the illegal trade of body parts, who has recently joined the University of Bath's Centre for Death & Society.

There are more than 7,500 patients in the UK currently on the waiting list for organ donations. Whilst nearly 16 million people in the UK, a quarter of the population, are registered as organ donors, bereaved families have the final say as to whether the organs of their loved ones are used in a transplant. This can lead to delays and can sometimes mean that the deceased person's organs are not used.

Dr John Troyer, who started a RCUK fellowship at the University in September, said: "In the UK we currently have an 'opt in' system of organ donation, where donors can register their consent for their organs to be used after their death.

"I believe a better alternative to this would be an 'opt out' or so-called presumed consent system where organs are used unless the person has specified their wish otherwise. This would encourage people to talk to their loved ones about donating their organs when they die and could have a real impact on the huge waiting list."

Dr Troyer says there is currently an illegal global trade in most body parts, with teeth, nails and bones being sold on the black market to be used as pharmaceutical products and skin being used to treat burns victims.

Organs such as kidneys are also being sold by living donors for large sums of money, with organs from the third world sometimes being used for first world patients who are desperate for a life-saving operation.

Some experts are calling for the selling of organs to be regulated rather than outlawed, to try and increase organ donation and to ensure a fair price to donors and their families. However, Dr Troyer believes this would be a dangerous step to take.

He said: "The reasoning behind regulating the organ trade is that by increasing the domestic supply of organs, the trade on the black market could be reduced.

"Another suggestion is that, instead of cash, families of deceased potential donors could be offered incentives to allow organ donation such as health insurance, funeral expenses or a gift to a charity.

"I believe that organ donation should remain altruistic - like blood donation - with the choice to opt out if preferred. This would make a big difference to the number of organs available and reduce the demand on the black market. It will also reduce the exploitation of poor people who sell their organs and endanger their health because they are desperate for money."

"Currently, the US has central organ database that matches available organs to patients on the waiting list. Whilst the UK has a national register of potential donors, there is no fast and easy way for doctors to check which organs are available."

He added: "Discussing death and dying is always going to be a taboo subject. The British are typically uncomfortable discussing death - the only time people seem to want to talk about it is around Halloween!

"My father was in funeral industry so I grew up around dead bodies, which probably explains why I was drawn to studying the field I do.

"But having my background I almost feel it's my obligation to start the debate and get people thinking about the difficult issues surrounding death and dying."

Earlier this year, ministers backed proposals to overhaul the donation system, although presumed consent was not amongst the proposals. However, over the next two weeks, the Welsh Assembly is holding a series of public debates to discuss the need to introduce a system of presumed consent.
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University of Bath

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