Organ donation and transplants

 

Sir, – Cystic Fibrosis Ireland is part of the seven patient groups in the Irish Donor Network that strongly welcomes the forthcoming legislation to change our organ donor consent from opt-in to soft opt-out that will be brought before the Cabinet in February.

The main reason why we support this change is not simply because almost every other country in Europe has the system but much more importantly because we as patient groups believe that it will increase the number of organs that will become available for life-saving transplants in Ireland.

In 2017 there were 593 patients in Ireland waiting for a liver, kidney, heart, lung(s) or pancreas transplant. That year, half of those on the waiting list (308) actually received a transplant, thanks to the fantastic work or transplant staff and the support of donors and their families. Sadly it was also the case that 33 people died in 2017 waiting for the “gift of life” that such transplants bring to those suffering from a major organ failure (sometimes suffering for many years).

Under the proposed new donor consent system, it will be presumed that most people in Ireland will want to donate their organs. This presumption is backed up by a nationwide survey undertaken in 2015 which showed 85 per cent of the Irish population are willing to donate organs.

Unfortunately the same survey showed that only 36 per cent of us carry a donor card and only half of us have ever talked to our next of kin about organ donation.

In short, the new consent system proposed by Government and supported by the Irish Donor Network will help bridge the gap between our intent and behaviour in respect or organ donation and will bring our system into the 21st century.

Under the new system, an online opt-out register will be available for those that don’t want to donate their organs.

However, it is important to point out that the proposed new soft opt-out system will still allow next of kin to be consulted before organ donation proceeds.

This is an important protection from an ethical perspective and also because a hard opt-out system (whereby next of kin have no say) was tried and failed in at least one EU country (Austria).

There was also a sharp fall in transplants from deceased donors in 2018 compared with 2017 in Ireland: 231 transplants from 80 deceased donors were undertaken in 2018 compared with 308 transplants from 99 donors in 2017. One of the likely contributory factors is the welcome reduction in road traffic fatalities in recent years. However, this means that there is an even stronger imperative for why we need to try and maximise the number of organs available for transplant, as fewer become available.

Changing the organ donor consent system is the single most important way this can be done. This needs to be further backed up by increasing the number of nurses, surgeons and recovery rooms in hospitals for transplants.

The impact of transplantation can be life-changing as well as life-prolonging. The excellent RTÉ documentary on Orla Tinsley who benefited from a double lung transplant shows how both length and quality of life can be improved through transplantation.

We would strongly urge that the Government completes the long promised change to soft-out organ donor consent as soon as possible and in doing so vindicates the promise made in the Programme for Partnership. – Yours, etc,

PHILIP WATT,

Chief Executive,

Cystic Fibrosis Ireland,

(Chairman,

Irish Donor Network),

CF House,

Lower Rathmines Road,

Dublin 6.

Sir, – I welcome Laura Kennedy’s invitation to discuss the issue of consent in organ donation, and specifically the opt-out system that the Government plans to introduce (“Will an opt-out organ donation scheme impact our bodily autonomy?”, Life, January 16th).

This is a system whereby organs will be removed from patients’ bodies upon death, for transplant, if they have not expressly forbidden it. Otherwise, consent will be presumed.

The opt-out regime is based on the assumption that when inevitable death is approaching, the State or the hospitals own our bodies and can dispose of their parts, unless we or our family explicitly object.

This principle is not acceptable, even if it is motivated by the noble intent of addressing the problem of shortage of organs for transplant in Ireland.

Donation should arise from an informed and deliberate decision.

An opt-out system does not properly respect the principle of informed consent.

If the current opt-in regime is not adequate to satisfy the need for donors, it could be improved so that every patient, when visiting their GP or a hospital, should be explicitly asked to express their option on the matter.

An opt-out system is detrimental not only for those who are not aware of the details of the legislation, probably the majority of people, but particularly for vulnerable groups in society such as those who do not have adequate language skills, or cannot fully consent.

Donation must remain a choice freely made and taking without asking is not giving. Our organs are not at the State’s disposal. – Yours, etc,

Dr ANGELO BOTTONE,

Research Officer,

The Iona Institute,

Dublin 2.

Sir, – Laura Kennedy has written a sincere and thoughtful piece on the ethics of organ donation.

Let us not forget, however, that for those waiting for an organ transplant, this issue can be quite literally a matter of life and death. – Yours, etc,

LOUISE NOONAN,

Dublin 12.