A Shift To An Opt-Out Organ Donation Is Welcome But We Must Talk More About Death

Professor John Forsythe
I think it is fair to say that Theresa May's conference speech is unlikely to make it into the next edition of "speeches that saved the world".

I think it is fair to say that Theresa May's conference speech is unlikely to make it into the next edition of "speeches that saved the world". Yet, buried within her words, I believe there was a nugget that may save people's lives.

I am highly privileged as I have been a transplant surgeon for over 25 years and have witnessed the remarkable transformation that the gift of organ donation can bring about. Sometimes, I walk past somebody in the corridor and they say, 'are you not speaking to me today?' This is because the person that I remember was close to death - someone who was ravaged by a disease causing organ failure. The person who passes in the corridor looks fit and active -returned to near normal life. That's why I don't recognise them.

Recently I met somebody whose transplant I performed 15 years ago. They still remember the exact words that I said to them before and after the operation, seared on their memory by the gift from a stranger. I am highly privileged. But I am only a technician who has passed on the life saving gift from the organ donor.

Set against this, you might ask how anybody ever turns down the possibility of donation to a needy transplant recipient. Honestly, I am not that judgmental. Put yourself in the place of a family member who, by definition, has just been told that their loved one is dead or is dying. You will be at the end of your tether. You will not want to be asked to choose a hot drink. Far less will you wish to ponder whether your family member really wanted to be an organ donor.

That is why the organ donation organisation for the UK, NHS Blood and Transplant, strongly advocates that people should talk about this issue; they should know what their family members want. In the Western world we tend to have a taboo about discussing such matters. Perhaps we feel that, if we talk about it, it may happen. But the difficult question about organ donation, posed at a tragic situation, is much easier to deal with if you have already had the conversation with your family member.

The nugget in Theresa May's speech was an announcement about a consultation to change the law in England towards the presumption of consent for organ donation in circumstances such as those that I describe. This follows on from a new law in Wales where deemed consent to organ donation is the norm and planned legislation in Scotland.

Approximately 10 years ago, I was less in favour of a legislative change on organ donation. Then, I had listened to the words of Rafael Matesantz, the architect of the system in Spain, acknowledged as the best organ donation system in the world. Rafael said that Spain had had the same legislation for organ donation before during and after its major transformation to a top level transplant country. He indicated that the infrastructure changes that he had put in place were much more important.

From that advice, we in the UK put in place similar huge change in the organ donation and transplant infrastructure across the United Kingdom. This has brought a tremendous increase in the number of organ donors so that, at last, we are seeing the waiting list for transplantation reducing. For instance the waiting list for kidney transplantation is now down by 27%.

But much more can be done. There is still evidence that families turn down the possibility of organ donation from their loved one much more frequently in the UK than in Spain. It is clear that the community of the UK is now strongly in favour of organ donation and a legislative change may encourage families to have the conversation about organ donation so that relatives know and agree to donation.

So the nugget in Theresa May's speech was very welcome. It will encourage more people, even as the legislation is crafted and agreed, to talk about the taboo subject of death and donation. More organ donors will mean more lifesaving transplants. Perhaps it will mean more times when I will be stopped by patients in the corridor "Prof, its me!".