Organ Donation: Opting-Out or Opting-In

organ donor2

Organ donation rates in Ireland fell 17% in 2012, from a record high in 2011, placing us below the international average. Under new proposals by Health Minister James Reilly, Ireland could switch its organ donation policy from ‘opt-in’ to ‘an opt-out’ option.

Healthy organs would be harvested from the deceased as a matter of course unless the deceased person had registered themselves as wanting to opt-out. The next of kin would retain their right to halt the donation procedure, which the Department of Health emphasise makes this option a so-called ‘soft opt-out’.

Although the core argument made by the Health Minister and supporting
parties is that this will automatically raise the number of organs available for donation, not everyone is convinced. NewsFour spoke with Fianna Fáil Senator Mark Daly, who feels the new proposals are misguided.

The Senator regards the opt-out proposal as compounding the recent error where they divided the responsibility for quality and safety of organs for transplant between the Irish Medicine Board and the HSE, so that now there’s no central authority to oversee and make decisions.

“The opt-out approach is a distraction from what works. Other EU countries have tried it and it doesn’t increase rates of donation in real terms. Spain adopted it from 1979 to 1988, before changing policy. What works is having an Organ Donor Co-ordinator in hospitals, talking with families.”

Characterising the proposal as being equivalent to setting a national speed limit for all roads and then firing all the guards, Senator Daly also felt that the idea of making everyone a de facto organ donor conflicted with the stipulation that the next of kin retain power of consent. This seems to be a contradiction.

In agreement with the Senator is Mark Murphy, CEO of the Irish Kidney Association. “Opt-out is a complete waste of time. In practice, the next of kin have to be approached, so they have the final word.”
Mark explained that the opt-out was first brought to government attention under the previous Fianna Fáil/Green Party administration.

“A report was submitted to Mary Harney’s office by a Deidre Madden of Cork University, and was discussed at a policy round table in 2009. I was in attendance and was one of the 30 out of 31 attending representatives who said: ‘Please don’t do this’. Harney listened to us.”

In 2011 however, the Labour Party’s manifesto featured the opt-out model as a proposed solution to the low number of donors. “Presumably, they were not aware of the previous rejection of the Madden Report.”

The Department of Health argue that presumed consent is standard in the EU with the exceptions of the UK, Germany and the Netherlands, and that the next of kin retaining consent is a practical advantage to the system, rather than a contradiction.

However, countries like Spain, Belgium and Austria, which have the most limited form of opt-out system, have very high rates of organ donation. Mark Murphy insists that Donor Co-ordinators be trained and paid by an independent body, which they would also report to.
“Independent assessment could lead us, as in the UK, to as much as a 50% increase in donor numbers.”

By Ruairi Conneely