1. Presumed consent is not informed consent
Resolution submitted by the RCN Pain Forum
That this meeting of RCN Congress opposes any attempt to make consent to organ donation presumed
Report on this debate
In the first debate of Congress 2008 members voted against the resolution that Congress should oppose any attempt to make consent to organ donation presumed.
The resolution was submitted by the RCN Pain Forum in response to calls for the introduction of an ‘opt-out’ system of organ donation in order to increase the numbers of organs available for transplantation.
The current ‘opt-in’ system requires individuals to give informed consent to donation but currently less than 25% of the UK population is on the NHS Donor Register.
The debate was opened by David Mathis from the RCN Pain Forum who said that while the Forum is fully supportive of the need to raise levels of organ donation, the ‘opt-out’ system would not acknowledge the importance of individual autonomy and the right to self determination.
Dominic Walsh from the RCN Critical Care Forum was the only speaker who urged members to vote against the resolution. Dominic spoke of his personal experience as a charge nurse working with liver transplant patients. Having seen the huge impact that organ donation can make he would not support a resolution that could restrict the number of organs available.
Other speakers mentioned a variety of concerns regarding the introduction of an ‘opt-out’ system. There were particular concerns about how vulnerable people, such as those with mental health issues, poor access to health services or a limited knowledge of English, would be protected under such a system.
There were a number of calls to encourage a wide public debate on the issue which is something already supported by both the Scottish and the Welsh Assembly Governments.
Result
The resolution was defeated in a card vote. There was no count of the vote.
Our online poll results were as follows:
| Yes |
36 | 28.8% |
|---|---|---|
| No |
89 |
71.2% |
Background
Current organ donor legislation requires that an individual gives his or her informed consent to donation; this is commonly referred to as an ‘opt-in’ system, although less than 25 per cent of the UK population is on the NHS Organ Donor Register. It has been suggested that an ‘opt-out’ system, where it is assumed that individuals are willing to donate their organs after death unless they have stated otherwise, would be fairer and would increase the numbers of organs available for transplantation.. However, calls for a change in the law to allow for an opt-out system of organ donation have been criticised for failing to acknowledge the importance of individual autonomy and informed consent to the organ donation process. In England, Wales and Northern Ireland, the removal of organs after death is covered by the Human Tissue Act (2004) (Parliament, 2004) and in Scotland by the Human Tissue (Scotland) Act 2006 (Scottish Executive, 2006).
An opt-out system potentially bypasses the requirement for informed consent, and thereby risks overriding individual autonomy, although it should be noted that a system of presumed consent would still take the views of relatives into account. Relatives would be informed that the deceased had not opted-out of donation; unless the relatives objected, the donation would proceed. It is generally acknowledged that any change to current UK law would require significant public support.
In January 2008 the government announced it would back the recommendations of the Organ Donation Taskforce (Department of Health, 2008), which could see a 50 per cent increase in organ donation in the UK within five years. Although the taskforce did not consider legislative changes, such as presumed consent, it has been asked by the Secretary of State for Health to consider whether a change to presumed consent would increase the number of organ donors, and to submit a report in 2008. The Scottish Government (Scottish Government, 2007) fully supports the work of the UK-wide Organ Donation Taskforce, and plans to encourage a wide public debate on the issue of presumed consent for organ donation. In November 2007, the Welsh Assembly Government Minister for Health and Social Services stated: "I have made it clear that I am in favour of considering presumed consent as a way of increasing the number of organ donations. However, I am also clear that, in the end, this is a matter which must be led by lay rather than clinical opinion and informed by a wide-ranging public debate. I have therefore commissioned a consultation document about presumed consent which I intend to launch in the spring of next year. I want to see a series of public debates all around Wales to ensure that everyone who wishes to participate has an opportunity to do so."
In Northern Ireland, the DHSSPS has recently endorsed the work of the Organ Donation Taskforce and its health minister has stated: “These UK-wide recommendations should go a long way to increasing the supply of donor organs to meet demand.” The debate on presumed consent will take place in Northern Ireland, as elsewhere, within the framework of the taskforce recommendations.
References and further reading
Department of Health (2008) Organs for transplants: a report from the Organ Donation Taskforce, London: DH. Available from: www.dh.gov.uk/en/Publicationsandstatistics
Parliament (2004) Human Tissue Act 2004, London: Stationery Office.
Available from: www.opsi.gov.uk/acts/acts2004/ukpga_20040030_en_1
(Accessed 31 January 2008) (Internet).
Scottish Executive (2006) Human Tissue (Scotland) Act 2006, London: Stationery Office. Available from: www.opsi.gov.uk/legislation/scotland/acts2006/asp_20060004_en_1
(Accessed 31 January 2008) (Internet).
The Scottish Government (2007) Better health, better care: action plan, Edinburgh: Scottish Government. Available from: www.scotland.gov.uk/Publications/2007/12/11103453/0
(Accessed 31 January 2008) (Internet).
Wrightson N and Neades B (2004) Should we change the law on organ donation? Nursing Times, 100 (35), p.19.