English: Selection of internal organs in human...

Selection of internal organs in human anatomy. (Photo credit: Wikipedia)

I started carrying an organ donation card when I was still at school. I still do and, to avoid ambiguity, I’ve confirmed my intentions in my will and written letters to my executors (somewhat to their alarm). I would encourage anyone to do the same. As far as I’m concerned, it’s a no-brainer.

Yes, everyone should do it (or think about doing it), but people don’t . They don’t get round to thinking about it and they don’t get round to doing it. That may be partly because the people who’s job it is to recruit organ donors aren’t very good at their job or partly because people have a “head in the sand” attitude to thinking about what happens when they die. And the consequence of this failure to plan responsibly is  additional stress, anguish and even family feuds.

Anatomy Act 1832So why am I so uneasy about the Welsh Assembly‘s decision to introduce a law of presumed consent? This works on the basis that unless a person has explicitly opted out of organ donation, they will have presumed to have given consent. Families can only object if they can convince the medical authorities that the deceased had expressed a clear wish their organs should not be used for transplantation.

What I don’t like is the way in which it upsets the relationship between the citizen and the state by, effectively, giving the state the power to seize bodies at the point of death without regard for the feelings of the family.

Anatomy Act 1832More disturbing is  the fact that the medical authorities can ignore the wishes of families where there the deceased hasn’t made an express wish. This was the concern raised by church leaders (who support organ donation as such) and which, on reflection, seems to flow from a very proper pastoral concern for newly bereaved families. What the Assembly seems to have done is created a check-box law that claims to be motivated by compassion, but which ignores the complex and, yes, sometimes irrational human dimension.

In this age of “rights”, the rights of bereaved families to be involved in decisions are now less than they were under the 1832 Anatomy Act. I don’t think that families should be able to override the express wishes of the deceased to donate or not donate and suspect that most families are likely to respect those wishes and may  find comfort in doing so. I do, however, think that they should be included in the process and be involved in the decision making, where possible and particularly where the deceased’s wishes are not clear.

Anatomy Act 1832How the Act will work out in practice remains to be seen.

Will more people be nudged into opting in to organ donation? Will large numbers opt out? Are doctors really going to ride roughshod over grieving families? One would hope not. Are people without families going to automatically become the property of the state?  Will organ recipients be told whether their new transplant was donated or not? Would you wish to receive an organ from someone who hadn’t given consent or which had been taken against the wishes of their family?

Organ Donation UK
Welsh Assembly