Re: Margaret McCartney: When organ donation isn’t a donation
The first full accounting year for deemed consent for organ donation in Wales has just been completed, and we await with interest the statistics from NHS Blood and Transplant. These will be available in a few months. Margaret McCartney's Comment comes at an opportune moment, and reminds us that it is far too early to make any claims for or against the deemed consent system in Wales. Because of Wales' relatively small population, it will take several years before any valid assessment can be made. This has not inhibited prestigious organisations such as the BMA, quality newspapers such as the Guardian, and senior politicians in Wales from claiming that the system is a success that has already saved dozens of lives.
The Chief Medical Officer for Wales, Dr Frank Atherton, in commenting on Dr McCartney's article, agrees that it is too early to assess the efficacy of deemed consent. He nevertheless offers the view that "The first year of the new policy gives cause for optimism that Wales is moving in the right direction". However, figures from NHS Blood and Transplant showed that there had been only 39 donors from hospitals in Wales for the 9 months from April to December 2016, whereas in the preceding 12 months there had been 64 donors. By contrast, in Scotland, there had been 95 donors from April to December 2016, in comparison with 99 donors in the whole of the previous year. For the UK as a whole, the donation rate was slightly higher in April to December 2016 in comparison with the previous year.
Dr Atherton also states that "Experience from other countries which have adopted an opt out legislative framework for organ donation suggests that it can take several years for improvements to be seen in organ donation rates" . If this statement means that the legislation can take several years to have an effect, there is no evidence for it. In fact, if there is one statistic where one might expect to see an immediate effect of deemed consent legislation it is consent rates. For the 2015/2016 year, consent rates for organ donation (DCD and DBD) were 61.8 % in the UK as a whole. For England, Northern Ireland, Scotland and Wales the figures were 62%, 58.9%, 57.1% and 59.2%. In that year, deemed consent was in operation in Wales for the last 4 months. It will be interesting to see the consent rates for the 2016/2017 year, due shortly. By comparison, it is worth noting that Spain, which does not operate a presumed consent system (and in fact requires families to sign a consent form even when the donor's consent is explicit) has for many years had a family consent rate of around 85%.
Dr McCartney's article also highlights the risks and uncertainties of deemed consent. These issues are discussed in more detail in "Presumed consent for organ donation: a clinically unnecessary and corrupting influence in medicine and politics", in Clinical Medicine Volume 14, pages 567 - 571 (2014).
Rapid Response:
Re: Margaret McCartney: When organ donation isn’t a donation
The first full accounting year for deemed consent for organ donation in Wales has just been completed, and we await with interest the statistics from NHS Blood and Transplant. These will be available in a few months. Margaret McCartney's Comment comes at an opportune moment, and reminds us that it is far too early to make any claims for or against the deemed consent system in Wales. Because of Wales' relatively small population, it will take several years before any valid assessment can be made. This has not inhibited prestigious organisations such as the BMA, quality newspapers such as the Guardian, and senior politicians in Wales from claiming that the system is a success that has already saved dozens of lives.
The Chief Medical Officer for Wales, Dr Frank Atherton, in commenting on Dr McCartney's article, agrees that it is too early to assess the efficacy of deemed consent. He nevertheless offers the view that "The first year of the new policy gives cause for optimism that Wales is moving in the right direction". However, figures from NHS Blood and Transplant showed that there had been only 39 donors from hospitals in Wales for the 9 months from April to December 2016, whereas in the preceding 12 months there had been 64 donors. By contrast, in Scotland, there had been 95 donors from April to December 2016, in comparison with 99 donors in the whole of the previous year. For the UK as a whole, the donation rate was slightly higher in April to December 2016 in comparison with the previous year.
Dr Atherton also states that "Experience from other countries which have adopted an opt out legislative framework for organ donation suggests that it can take several years for improvements to be seen in organ donation rates" . If this statement means that the legislation can take several years to have an effect, there is no evidence for it. In fact, if there is one statistic where one might expect to see an immediate effect of deemed consent legislation it is consent rates. For the 2015/2016 year, consent rates for organ donation (DCD and DBD) were 61.8 % in the UK as a whole. For England, Northern Ireland, Scotland and Wales the figures were 62%, 58.9%, 57.1% and 59.2%. In that year, deemed consent was in operation in Wales for the last 4 months. It will be interesting to see the consent rates for the 2016/2017 year, due shortly. By comparison, it is worth noting that Spain, which does not operate a presumed consent system (and in fact requires families to sign a consent form even when the donor's consent is explicit) has for many years had a family consent rate of around 85%.
Dr McCartney's article also highlights the risks and uncertainties of deemed consent. These issues are discussed in more detail in "Presumed consent for organ donation: a clinically unnecessary and corrupting influence in medicine and politics", in Clinical Medicine Volume 14, pages 567 - 571 (2014).
Competing interests: No competing interests