woman at computer considering organ donation

Move to opt-out organ donation is a real risk

11th Jun 2019 - James Mildred

MSPs are taking a real risk by voting in favour of a new opt-out organ donation system, CARE for Scotland said this evening.

The warning comes after MSPs voted by 116 to three, with two abstentions, in favour of changing Scotland’s organ donation from its current opt-in system, to an opt-out system.

The Human Tissue (Authorisation) (Scotland) Bill will mean donors are automatically enrolled by the state, unless they choose to be removed from the list.

This fundamentally alters the nature of organ donation, shifting it from being a genuine gift to one where consent is presumed.

Under the previous opt-in system, Scotland led the way out of the four home nations when it came to the number of registered donors to the organ donation register.

But the new system could lead to potential donors removing themselves from the register they find the idea of the state presuming their content offensive, CARE for Scotland warned.

While supporters of the opt-out system often cite Spain as an example to follow, experts have insisted the country’s record on organ donation is due to other factors, such as education, rather than the legislation it has in place.

CARE for Scotland National Director, Dr Stuart Weir said:

“We have consistently warned that the international evidence available does not suggest moving to an opt-out system in and of itself increases organ donation levels. 

“MSPs are taking a real risk here because we are talking about time and money being spent on radical shift in the way we do organ donation and there’s no guarantee the change will work.

“It is also highly possible potential donors, who are opposed to the state presuming their consent, will be put off by this change and will then opt-out in protest which would be a real shame and would not happen under the opt-in system, where organ donation remains a genuine, voluntary gift.

“Scotland already leads the way in terms of the number of people on the organ donation register and we are concerned this change of system could undermine this.

“Of course, we want to see more organ donors and we fully recognise the absolute imperative of increasing organ donor levels and reducing waiting times. 

“But this move by itself won’t be enough and the Scottish Government must ensure it commits to a publicity campaign so people are properly informed about what this change will mean.  

“We also need more specialist organ donation nurses because what the evidence does show is that when they are available, patients are more likely to donate.”


Notes to editors:

For interview requests or more information please contact James Mildred: james.mildred@care.org.uk // 07717516814

CARE is a well-established mainstream Christian charity providing resources and helping to bring Christian insight and experience to matters of public policy and practical caring initiatives. CARE is represented in the UK Parliaments and Assemblies.  

The text of the Bill can be read here: https://www.parliament.scot/parliamentarybusiness/Bills/108681.aspx

CARE for Scotland has consistently argued for a different approach:

In September 2018, CARE for Scotland argued that the proposed shift to an opt-out system would not work: https://www.care.org.uk/news/latest-news/opt-out-organ-system-will-not-work

In November 2018, CARE for Scotland gave oral evidence before the Health and Sport Committee: https://care.org.uk/news/latest-news/opt-out-organ-donation-just-placebo

In February 2019, when MSPs approved the general principles of the Bill, CARE for Scotland warned that the legislation was flawed: https://www.care.org.uk/news/latest-news/msps-should-reject-flawed-organ-donation-bill

CARE’s Director of Parliamentary Affairs, Dr Dan Boucher previously spoke to BBC Radio Scotland explaining why an opt-out system does not lead to an increase in organ donor levels: https://care.org.uk/news/latest-news/dan-boucher-bbc-radio-scotland-does-opt-out-organ-donation-work

Lessons from Spain

Spain is the world leader when it comes to organ donation. But experts there have said the country’s exceptional record is not due to opt-out organ donation. In this article for the British Medical Journal written by leading organ donation experts Prof John Fabre, Paul Murphy and Rafael Matesanz, explain why, when it comes to assessing Spain’s organ donor levels, ‘presumed consent’ is a distraction: Entitled ‘Presumed consent: a distraction in the quest for increasing rates of organ donation,’ the article states: ‘Crucially, Spain does not have an opt-out register for those who do not wish to become organ donors. Not a penny is spent on recording objections to organ donation by Spanish citizens, nor on public awareness of the 1979 legislation.’  -    BMJ 2010;341:c4973.

In this article, the director of The National Transplant Organisation in Spain, Beatriz Dominguez-Gil dismisses the idea that changing the law will have a transformative effect: https://mosaicscience.com/story/spain-uk-organ-donation-transplants-liver-kidney-heart-lungs-surgery-nhs/

KEY QUOTE: “When I ask what advice Domínguez-Gil would give countries like England when it comes to improving donor rates in general, she emphasises the need make sure intensive care staff deal with the potential for their patients to become donors as a routine part of their job. “Because that’s quality of care in intensive care as well,” she says. She also stresses that continuously training professionals in how to handle this is a must. Importantly, she waves away the idea that legislative upheaval will be transformative. “I wouldn’t be making a big effort in changing the law,” she says. “We know that the key for success is elsewhere.”

What about Wales?

Wales introduced an opt-out law in December 2015, and two years later in December 2017, a study confirmed that Wales’ opt-out system had not increased donors: https://www.bbc.co.uk/news/uk-wales-42213813

Opposing opt-out does not mean being anti-organ donation

Despite misgivings about an opt-out system, CARE is not opposed to organ donation and in September 2018, to coincide with Organ Donation Week, CARE ran a week-long campaign to raise awareness about the importance of organ donation: https://www.care.org.uk/news/latest-news/care-launch-new-campaign-highlight-organ-donation

Scottish Government’s own policy memorandum

CARE’s call for wider investment in education fits with the Scottish Government’s own policy memorandum which highlights the fact that an opt-out system alone does not increase donations:

Paragraph 30 of the Scottish Government’s policy memorandum on international evidence of organ donation says: "International evidence suggests that opt-out legislation can be effective as part of a package of measures to increase organ donation, however, there is insufficient robust evidence to conclude that opt-out legislation alone will increase deceased donation. The evidence highlights the importance of a range of non-legislative measures, which can work effectively in their own right to increase donation and transplantation and which are often associated with successful optout systems. International evidence highlights that there is an association between countries with opt-out legislation and people‘s increased willingness to donate their organs, as well as an association with increased deceased donation.  Despite this association, there is limited robust evidence that shows soft opt-out organ donation causes increases in deceased donation." Para 30


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