The meaning of consent
Organ donation in the UK currently relies on the principle of
Informed consent is an 'opt-in' model - people
have to sign up to donate organs. In this model, donors must also
be made aware of what they are signing up for and have the option
of withdrawing their consent at any point.
They must also not face any inducements to
donate organs - it is seen as an entirely voluntary, altruistic
gesture that benefits others.
Only people aged 16 and over can consent to organ donation. For
children, parents or legal guardians make decisions.
Some difficulty surrounds the ability of people with forms of
mental impairment to make informed medical
decisions. Generally, family members or legally specified
individuals decide based on the presumed wishes of the donor.
Informed consent contrasts with presumed
consent (the assumption that an individual is happy to
donate organs after death unless he or she has explicitly said that
they do not wish to).
Presumed consent is controversial because medicine is founded on
the notion of patients having the right to choose what medical
procedures are carried out on them. Some argue that this right
should extend to disposal of the body or parts of it after
Others argue that medicine has a moral responsibility to
patients in need of organs, and that the rights accorded a living
person do not apply to a dead body.
In practice, presumed consent can be either
'hard' or 'soft': in a soft
approach, relatives are approached and have the opportunity to
request that organs are not used even if the deceased has not
specifically opted out. This is the position recommended by the
British Medical Association.
Spain is often held up as a country where opt-out systems have
led to an increase in transplantation - it carries out around 34
transplants per million of population while the UK manages just 13
per million. A study carried out in 2006 suggested opt-out systems
typically increase the numbers of transplants by around 25-30 per
To support its system, Spain has established a sophisticated
transplant network, which includes specially trained staff who
liaise with families after a death. In particular, 'organ
procurement officers' have the sensitive task of dealing with
grieving relatives, to persuade them not to block the harvesting of
organs. An insight into this key role can be seen in Pedro
Almodovar's film 'All About My Mother' - the main character,
Manuela, is a procurement officer.