The issue of organ donation after death has sparked a number of media news stories recently. There is a real shortage of organs available for transplant which has led to several proposalsintended to increase the supply of organs.

The Welsh Assembly plans to introduce 'presumed consent' to organ donation within five years. (1) A public consultation on this begins soon. If Wales introduce it, then the rest of the UK is more likely to follow suit. The Northern Ireland Health Minister has said he would like to introduce presumed consent in Northern Ireland. (2) The BMA debated organ donation at their Annual Conference this year, voting to support presumed consent. (3)

Currently, individuals in the UK can only donate their organs after death if they have registered as a donor. Under a 'presumed consent' (4) law every person would automatically become an organ donor on death, unless he/she has specifically registered to 'opt out'. The Welsh Assembly is advocating a 'soft' system of presumed consent, in which relatives would be able to veto organ donation even if no formal objection to it had been made by the deceased person.

Adding to the debate, and offering another possible solution to the organ shortage, the Nuffield Council on Bioethics has suggested that the NHS could pay the funeral expenses for those who sign the Organ Donor Register and subsequently become organ donors on their death. (5)

CMF submitted a response to the initial Welsh Assembly consultation, setting out in more detail our thoughts on this issue. (6) In essence, while we fully support organ donation and welcome the increase of registered organ donors in the UK (30% are now registered, 18 million in total (7)) we are concerned that a system of presumed consent effectively equals no consent, unless there were to be an extensive public information programme, capturing the entire adult population, including those on the margins of society. Without this, it would be impossible to ensure that those who do not opt out have made a positive choice, rather than doing so by default, by ignorance, or by a lack of knowledge or understanding. Without consent, donation becomes 'taking' organs rather than 'giving' them.

There are further issues around the ascertaining and timing of a diagnosis of death, about bodily integrity, about trust in professionals and about the role of donation as an altruistic gift. It is also questionable whether legislative changes are necessary, or whether structural changes that make it easier to donate are effective.

As the pressure to increase donation rates grows, we need to ensure that organ donation after death remains a genuinely altruistic gift. If there is any undermining of this gift, either through a hint of financial incentives and/or an element of felt duty, the gift principle will be undermined fundamentally changing the nature of the exercise.