The Great Organ Debate

Easing back into politics after the Christmas break, Prime Minister Gordon Brown decided to carve out a position as a decisive leader willing to make tough choices on the difficult issues. His subject choice? The UK’s system of organ donation.

In an article Mr Brown penned for the Sunday Telegraph newspaper, he came out in favour of a new system of ‘presumed consent’ for organ donation to help the one thousand people who die each year waiting for transplants. Essentially, ‘presumed consent’ would automatically place people on the organ register unless they opted out, a system which Mr Brown believes ‘has the potential to close the aching gap between the potential benefits of transplant surgery and the limits imposed by our current system.’

At first glance, the question of organ donation seems – my apologies for the pun – a no brainer. Is it not ridiculous that every day people are buried with organs that could save someone else’s life for the simple reason that they do not have a donor card? And of course with a system of presumed consent, those who object can always opt out. Many would argue that we need to forget our carnal obsession with the worth of our dead bodies and look at the bigger picture – we certainly do not need our organs when we are gone.

And we don’t. But this issue is not as simple as it would appear. To whatever degree Gordon Brown’s desired ‘national debate’ will be dominated by those in the medical community, one must remember that death for many people is a sensitive matter. The delicate ethical, social and spiritual issues which surround the ownership of the deceased’s body should not be cast aside for the seemingly unquestionable aims of medical advancement and the preservation of life at all costs. In too many of today’s debates, I believe we are giving undue weight to the scientific community – whether over embryology, fertilisation, organ donation – and seem to have forgotten the sanctity of the individual body. Use and function apparently reign supreme. This cannot go unchallenged.

The terms ‘presumed consent’ and ‘compulsory donation’ do not sit easily with me. Under the current system, donors are exactly that – people who have provided the ultimate gift of life. Any anthropologist can tell you that there is a vital symbolic difference between the giving of gifts and the taking of something through compulsion. Listening to a phone-in on a popular radio show, one gentleman who had received an organ said that it was crucial to him that it was a gift. He would not have been happy to receive something where the donor was less a donor and more a name on an automatic register.

The concept of presumed consent allows the state control of your body unless you say otherwise. This is effectively the nationalisation of the one thing we can truly say belongs to us and fundamentally alters the relationship between individual and state. If implemented, the new system would represent yet another heavy step of this Labour government into the private sphere, allowing the state to not only dictate what we should eat and how we spend our leisure time but also what happens to our dead bodies. Once we have passed away, I am sure most of us would first and foremost wish our bodies to be the property of our families. Gordon Brown did reassure in his article that the final decision over a person’s body under the new system would be left with the family. But only in cases where that person was not on the register. He is implying, therefore, that if someone is on the register, the family’s wishes will be overridden.

Going down the route of presumed consent could be, as with so many ethical issues, the first step on a decidedly slippery slope. Many of us will be familiar with news stories about the growing trade in organs in developing countries. It seems especially tragic that some of the most impoverished are forced to risk the one asset, their physical health, that they possess. The Chinese government has even been accused of selling the organs of dead prisoners without the consent of families. Do we in the UK really want to give ownership of our bodies to the State?

Putting aside the emotive arguments I have outlined, there are more pragmatic reasons why I regard the presumed consent system to be flawed. There are concerns that the NHS would simply not have the capacity to store organs on a larger scale. More frighteningly, however, there is also doubt over how to classify someone as dead before the removal of organs. Can we guarantee that the life of a potential donor will be treated as a priority over the need for his or her healthy organs?

Furthermore, there is little information about how the process of enrolment on the list would work. Would British citizens be enrolled at birth – including babies and children on the register? Or would enrolment happen at the age of eighteen? If this were the case, it would surely only be proper that we ensure people are sent information on opting out as soon as they come of registration age. And which organs would the state have access to? For sure, many people have no qualms over donating their kidneys, heart or liver to save a life. But how would people feel about face transplants or donating their eyes or even brains? Would being on the register also leave your body open to experimentation and would more general genetic material be protected?

No doubt if the government’s proposed scheme went ahead, many sections of our society – in particular religious groups – would lobby for automatic opt out. Those with unexplained distaste for organ donation, on the other hand, would experience great social pressure not to opt out. Indeed the reason opt out schemes can vastly increase participation is because people are either too lazy, unaware of their rights or dissuaded by social pressure to deregister – the very reasons why an opt out system is being considered for our pensions. I would defend the right of citizens not to have to explain their reasons for shunning organ donation either to themselves or to anyone else.

The government argues that any decision to change our donation system would not be made lightly. Dr Vivienne Nathanson, head of science and ethics at the British Medical Association has claimed ‘we have exhausted all other ways of increasing the number of organs available.’ But we must not blindly accept such statements not least from someone with such a clear self-interest. I have not been struck by high profile advertising campaigns promoting donations nor have I ever been asked by a doctor whether I carry a donor card nor been witness to the wholesale promotion of the online register. Moreover, I remain to be convinced that enough has been done to address the causes of the sharp increases in organ demand in recent years: much of the reason why there is such a need for liver donations, for instance, is because of the emergence of a serious binge drinking culture in our society.

There is plenty to be done before we take the very serious step of giving away the liberty over our own bodies. The Organ Donation Task Force is due to put forward its recommendations on presumed consent this summer and in the meantime I would call on constituents to sign up to the current organ register. By giving the gift of life we could just put a stop to the nationalisation of the body.