Gordon Brown has initiated a debate in the UK about how to increase that country’s dismally low organ donation rate. Brown has suggested that a “presumed consent” system be established under which organ donation after death would be assumed, unless individuals had opted out or their families opposed donation. The proposal has drawn strong objections from “patients’ groups” (yes, apparently there are such things as patients’ groups in the UK), who say organ donation is “a matter of individual conscience”.

Australia would do well to pay attention to this debate – we have one of the lowest organ donation rates in the world, and it has been static since the 1990s. Perhaps a lot of us thought Monty Python’s organ donation scene in The Meaning of Life was a documentary.

The sloth-like Australian Health Ministers’ Conference has repeatedly and ineffectually claimed to be addressing this, and in 2006 promised “a national reform agenda on organ and tissue donation” that focussed on establishing a(nother) taskforce, better identification of donors and yet more “awareness raising” and “social marketing” of organ donation.

You would assume this is exactly the sort of thing that Australians Donate was set up in 1998 to do – but a review 12 months ago found that that body was failing to achieve its goals. Meantime, people are dying waiting for organ transplants.

Marketing hasn’t worked for organ donation in Australia. It is time to consider stronger measures. An “opt-out” approach such as that being proposed in Britain would be a good start in lifting our performance.

Removing the capacity of grieving relatives to interfere with organ donation would be even better. Despite changes in 2005 to strengthen the recognition of organ donors’ wishes, relatives can still prevent them being honoured. Even if someone has registered as an organ donor, families are permitted to abrogate this clearly-expressed intention after death – and figures show up to 40% of them do so in both the UK and Australia.

In fact, there’s no ethical base for allowing any issue of consent in organ donation. The rights of the living outweigh those of the dead, and the right to live outweighs the right to exercise whatever peculiar eccentricities of religion or culture prevent relatives from agreeing to the use of a patient’s organs to save others. Organ donation should therefore be made compulsory. It is not a matter of “individual conscience” when the decision of a now-deceased individual or their families can harm or permit the death of someone.

Peter Fray

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