The question of organ donation

Somewhat unkindly, bikers are often referred to as "organ doners in waiting" - yet organ donation is a life choice that actually is widely supported in the biking world. It probably has something to do with the rather troubling statistic that bikers are 30 times more likely to die in accidents than car drivers. That kind of risk tends to concentrate the mind somewhat so it is hardly surprising that bikers generally take a more sanguine view of organ donation than do other sections of the population. Whilst by no means wishing to be fatalistic, there is no denying that as bikers we are at significantly greater risk of being killed while going about our business and so the widely held view seems to be that it is incumbent on us to take the necessary steps to ensure, should the worst happen, that our organs won't go to waste.

The facts are stark: more than 8,000 people in the UK need a transplant, but a shortage of donors means that fewer than 3,000 transplants are carried out annually. Around 1,000 people every year die for want of transplant surgery - as the British Medical Association puts it, 'bodies are buried or cremated complete with organs that could have been used to save lives'.

It is also estimated that over 95% of people support organ donation (and would accept a donated organ themselves) but only 27% of the population are on the organ donation register. The widely-held view is that something needs to be done to address this disparity.

Many would like to see the UK adopt (as other European countries have) a system of "presumed consent" - that is, a system that presumes that organs may be used for others upon death. No requirement to sign a register or carry a donor card, simply a system that assumes that the individual automatically will donate organs upon death, unless one opts out. Such a system would create a default position that life should be saved rather than a default position that life could be lost and this was the desired policy of our previous Government. Clearly, such a policy would represent a significant step-change from how the system currently works and when proposed it created quite a furore - not just amongst civil liberties and religious groups but also many in the medical profession. The memory of recent organ retention scandals (at Alder Hey and Bristol hospitals) casts serious doubt on whether it is right for healthcare professionals to ever presume consent. The proposal was quietly shelved after the previous Government were voted out of office.

So what is the answer? Well, the current Government is trying a different approach. From 1 August, new driving licence applicants will have to tick one of three boxes to answer a question on organ donation before they can complete their application:

• Yes, I would like to register
• I do not wish to answer this question now; or
• I am already registered on the NHS Organ Donor Register.

This is a pilot scheme to test the ‘nudge’ theory. It is thought that since a person is required to respond to the question, they will spend more time considering the question. It is hoped that the change will double the percentage of people choosing to join the organ donation register when applying for a driving licence. This "prompted choice" scheme has already been trialled successfully in several US states - for example, in Illinois, where the percentage of donors who have registered has increased from 38 per cent to 60 per cent since 2008. It is not yet known how the results will play out in the UK, indeed the scheme has been criticised in some quarters for not having an explicit "no" option. Presumed consent by the back door is the charge levied by opponents.

But really, what is there to oppose? Yes, there is a discussion to be had about systems and methods but surely noone can doubt that organ donation is intrinsically a good thing and should be promoted? I think the current "nudge" strategy is a good one but its drawback is that it only captures new driving licence applicants - the numbers still need to increase dramatically so other levers are needed. Personally, I would go further - I don't believe families should be allowed to refuse if the deceased has chosen to donate their organs. I am on the organ donor register but would be very unhappy if I thought that one of my family would seek to ignore my wishes and refuse consent when I die (not that there's much that I could do about it!).

Whether presumed consent is the right policy I'm not so sure. There are very significant political and moral difficulties to overcome and I'm not sure that argument is winnable. But we have to do better than the current numbers. The way to look at this is.... if you or one of your loved ones was in need of a transplant, would you accept a donor organ? If the answer is yes then really you should know what to do....

NHS Organ Donor Register can be found HERE