THE rules and conventions around organ transplants go to the very heart of the relationship between the individual and the state.
It is not only an ethically complex area but it involves two extremely vulnerable groups of people: on the one hand, patients who will die eventually, perhaps imminently, without a transplant and, on the other, grieving relatives at the very moment they are dealing with the initial pain and shock of losing a loved one. So any change in the arrangements, which depend on citizens making the altruistic gesture of joining the donor register and newly-bereaved families consenting to the procedure, must be handled with extreme sensitivity and caution.
The Donation and Transplantation Plan for Scotland 2013 to 2020, which broadly reflects the tone and recommendations of a parallel document covering England, will disappoint those who hoped the rest of the UK would move quickly to follow Wales in legislating to replace the opt-in system for an opt-out one. Instead, it recommends a watching brief, evaluating the change in Wales before deciding for or against a Scottish opt-out system. Also, what it calls a "hard-line approach", in which a transplant could go ahead in the face of opposition from the family provided the donor had authorised the procedure, will be the subject of public consultation. Such caution is commendable because any change must command public support.
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At present there is a disconnect. While almost everyone says they would accept a donated organ if their life depended on it, many of the bereaved refuse to agree to a donation when asked.
However, simply ignoring the relatives' wishes risks creating a backlash, as happened in Brazil, which has now abolished presumed consent. In fact, the change in Wales may not produce the revolution some anticipate, as clinical teams will continue to have to take the views of relatives into account, particularly where the wishes of the deceased are unknown.
It remains the case that the best guarantee of obtaining consent is where the individual has joined the register and discussed his or her wishes with the next-of-kin. That is why Scotland's success in signing up more than two million people (41% of the Scottish population compared with only 31% across the UK) is worth celebrating and building upon. The sterling efforts of The Herald's sister paper, The Evening Times, in publicising the plight of those waiting for transplants and the rejuvenation of those who have received a transplant have played a key role in nudging Scottish opinion on this issue in the right direction. For the same reason, more needs to be done to honour the generosity of donors publicly, as with the Loveseat in Kelvingrove Museum and Art Gallery.
Nevertheless, as the new plan acknowledges, the ultimate objective of saving more lives rests on much more than public information campaigns and changing attitudes. For instance, the introduction of Specialist Nurses for Organ Donation (Snods) has done much to break down resistance to transplants from both relatives and some healthcare professionals who are reluctant to raise the issue at such a sensitive time. The role of Snods needs to be enhanced so that opportunities for transplants are not wasted. And even an opt-out system will not increase transplants unless the right infrastructure is in place to conduct them. Recent progress on increasing transplants is encouraging but Scotland still compares poorly with other European countries.
We can do better. Helping someone to live after our death costs us nothing. Yet it is a priceless gift.