Organ donors

TODAY SOME 600 patients in Ireland, many with seriously life-shortening conditions, are waiting for transplants of kidneys, hearts…

TODAY SOME 600 patients in Ireland, many with seriously life-shortening conditions, are waiting for transplants of kidneys, hearts and other organs. Up to a third of those with cystic fibrosis awaiting lung transplant will die before a suitable donor becomes available. Yet, despite a real shortage of donors, Ireland's annual rate of donation is relatively high by international standards.

To boost the numbers and ease waiting lists, Senator Feargal Quinn will introduce his Human Organs and Body Tissue Bill this week to move from an "opt-out" to "opt-in" system in which potential donors will be presumed to have consented to give their organs unless they or their relatives specifically indicate otherwise. The international experience, it is argued, particularly in Spain where donor rates are a full 60 per cent higher than Ireland, suggests that the move can help dramatically overcome the reluctance of many hospitals to ask for donations at difficult times of bereavement.

Meanwhile the Government has ordered the drafting of its own Bill to regulate the issue of organ removal and retention, but it will be based on the "opt-in" principle.

Apart from increasing donor rates, however, an "opt-out" system has a number of advantages: families are still consulted, and may still veto a donation, but can be relieved of the burden of making a decision when they are uncertain of what their relative would have wished. And with international polling evidence suggesting that a substantial majority are happy to be donors - although smaller numbers carry donor cards - presumed consent is a better way of ensuring that the aim of respecting the wishes of the deceased can be observed.

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Some patients' groups have been uneasy about the issue, not least because of a breakdown in trust with the medical profession brought about by the organ retention scandal. Critics also argue that Spanish success was much more to do with the radical improvement in the recruitment and training of competent, pro-active hospital transplant co-ordinators who are better able to deal with grieving families. That sensitive challenge does not disappear with a change in consent rules, they argue, and needs urgently to be addressed.

Yet that is not incompatible with moving to presumed consent. A major 2006 international study found that, when other factors are eliminated, presumed consent can give rise to a 25-30 per cent increase in organ supply. For those desperately waiting for their chance this would represent real hope.