Ethics briefings

Taskforce rejects presumed consent for organ donation

In November 2008, the Organ Donation Taskforce published its report The potential impact of an opt out system for organ donation in the UK and more than 450 pages of supporting information.1 The Taskforce had been charged with considering the practical, ethical, legal and societal issues surrounding presumed consent, whereby all adults would be considered as potential donors unless they had opted out during their lifetime. It rejected such a shift, preferring to wait and see the impact of the significant reorganisation of the organ donation system recommended in its earlier report, before taking this more radical approach.2

The Taskforce concluded that the arguments around presumed consent were finely balanced. It reported the factors in support of change as:

• There is an apparent correlation between high donation rates and opt-out systems around the world.

• Deliberative events with the public showed that the majority would support a change (the summary says around 60%, although the supporting evidence shows that after the Taskforce’s own deliberative events 72% supported presumed consent).

• It found no fundamental legal or ethical barriers to introducing a “soft” system of presumed consent (with a role for the relatives).

Against change, it found:

• Some health professionals were concerned that trust between clinicians caring for patients at the end of life and patients and their families could be damaged.

• It heard powerful evidence from some recipients of organs that they needed to know the organs had been given freely by donors and their families.

• Putting in place an opt-out system that would command the trust of professionals and the public would be complex in practical terms and costly.

• Some members of the public supported an opt-in system and felt that assuming consent from silence “belonged to a more paternalistic era”.

• Some faith leaders warned of the potential for …