How close is Ireland to having an opt-out system for organ donation?

'Presumed consent' means anyone can become a donor of organs and tissues when they die unless they specifically choose not to

How close is Ireland to having an opt-out system for organ donation?

Former Minister for Health Dr James Reilly TD at the launch of Organ Awareness Donation Week in 2014. | Image: RollingNews.com

As of January 1st, every citizen in France is an organ donor unless they specifically decide to opt out.

A significant change in the legislation means people will now need to sign up to a new National Rejection Register to ensure they do not become organ donors, which medical teams will check at the time of death before considering organ or tissue removal. 

If it is not possible to sign up to the register, people can also sign and date a written refusal and leave it with a relative, or make an oral testimony to a relative who will then need to attest this wish to a medical team.

The Guardian reports that 150,000 people have already signed up to abstain from donating

Last month, Minister for Health Simon Harris outlined his desire to bring forward similar proposals to the Oireachtas Health Committee, as recent HSE figures put the number of people waiting on transplants at more than 600.

lungs donated as part of research at the University of North Carolina, Chapel Hill, sit inside a machine as they're ventilated and tested to see if they are healthy enough to transplant. Image: Allen Breed AP/Press Association Images

How we got here

In 2013, the Department of Health in Ireland undertook a public consultation on the practical aspects of introducing an opt-out system of consent for organ donation. 

A total of 57 submissions were received. 40 submissions were received from individuals while 17 submissions were received from organisations and representative groups including:

  • Irish Hospice Foundation
  • Irish Kidney Association
  • Irish Lung Fibrosis Association
  • Irish Medical Organisation
  • Forum on End of Life in Ireland

All of the above supported the introduced of a soft opt-out system, with the exception of the Irish Kidney Association (IKA).

In their submissions, the IKA said the association had "serious concerns regarding the plan to alter the consent system for donating organs from the deceased" and "failed to see any concrete rationale as to why this change should be made".

As part of the 2014 Programme for Government, the Department introduced a similar system of consent for organ donation, in which consent is deemed unless the person has, while alive, registered his/her wish not to become an organ donor after death.

The then-Minister for Health Dr James Reilly said following the consultation: "I firmly believe that the introduction of an opt-out system is an integral element in changing our cultural attitude towards organ donation. We need to make organ donation the norm in Irish society and to make it the default position for those people who die in circumstances where donation is a possibility."

However, it was proposed that, even though consent is deemed, the next of kin will be consulted prior to removing any organ.  If the next of kin objects to the organ donation, the donation will not proceed. This is known as a "soft" opt-out system.

Fast forward four years, National Projects Manager at the Irish Kidney Association Colin White said it's not about being against an opt-out system, but about operating an opt-in system alongside it.

"A yes/no register makes a lot more sense", he told Newstalk. "Why not capture the number of yes responses as well as the number that say no?"

"2008 was the last time an audit was carried out in intensive care units to find potential organ donors. This is something that should be carried out every year, so that associations like ourselves can see the groups we need to target, be it young people or people within a certain age bracket."

He also stressed that it's not just a case of opening the floodgates, as much as it ensuring that Ireland has the appropriate infrastructure to cope with it.

"Say we do introduce an opt-out system - do we have the infrastructure to provide enough appropriate aftercare to recipients? If you don't have that in place you'll blow the public's confidence in the organ donation system as a whole."

How do we compare?

Wales became the first country in the UK to overturn the system and operate on presumed consent in December 2015. The organ donation rate rose as a result from 49% to 59%. Mr White put this down to the country having a stronger infrastructure in comparison to Ireland.

He added that the £3 million PR campaign was put in place ahead of the system change ensured that organ donation was brought up on the public's conscience.

People in the UK must register as a donor, and it is common practice to let a relative know if someone would like to be a donor or not for doctors to take into consideration.

According to NHS Blood and Transplant, 6,416 people are currently waiting for a transplant in the UK. The number of people who have received a transplant since April 2016 is 2,726. 

Spain, which also operates a presumed consent law, has the highest organ donation rate in Europe with 36 donors per million people. The Spanish model is organised around teams of transplant coordinators.

Opposition

Mr White acknowledged that debate surrounding organ donation can be "quite emotive"

"You have to look at it from the donor's point of view as well as of the recipient's", he said. "The people who are dying as people at the end of the day. Let's not forget them.

"They [donors] are leaving a legacy to their own families. That's how organ donation needs to be viewed."

The HSE Organ Donation and Transplant Ireland (ODTI) has yet to publish its annual report for 2016. In 2015, 266 people received a n organ transplant.

Beaumont hospital provides kidney transplantation and is the national centre for living kidney organ donation. | Image: RollingNews.ie