Should the UK switch to an opt out organ transplant system?

In the UK there is currently an Opt in organ donation system. This is where people have to actively sign up to a register to donate their organs after death. In opt-out systems, organ donation will occur automatically unless a specific request is made before death for organs not to be taken. However, there is much deliberation over whether the current policy should remain in place or be changed.

For living people, the ability to control what happens to their bodies is acknowledged to be a fundamental right of all competent adults. Patient autonomy is a key legal and ethical concept that is so highly regarded that it even allows competent adults to refuse life prolonging treatment. (Somerville 2012) So why should we threaten this autonomy with something morally unjustifiable even if a policy sounds medically desirable? Patient autonomy may not be respected because they may be unaware of the changes put in place. If this is the case, then the consent by which the government are taking the organs is not informed and therefore is it justifiable to remove a person’s organs when they have not expressly said they want this to be done. This would go against the human tissue act 2004 because there is not the appropriate level of consent. A human’s relationship with their body can be hugely important to the value of their lives which places deontological constraints onto what others should be able to do with our bodies after we die. Furthermore, a lot of people have interests that survive their deaths including their faiths so ignoring these interests could be a showcase of disrespect and potentially cause posthumous harm. (Glannon W 2003)

On the other hand, the most attractive and persuasive facet of an opt out system is the potential increase in donation rates; it is assumed that there is a positive correlation between opt out systems and a rise in donation. More than 6,500 people in the UK need a transplant, but a shortage of donors means that around 3,500 transplants are carried out annually.  The British Medical Association recently recommended an opt out scheme with safeguards as the best method of improving organ donation rate. (BMA 2012) As we have found through medical experience, a transplanted organ has the ability to save someone’s life, and can also improve the quality for life for many. Despite the success of these surgeries, there is still not enough organs to meet the demands of the National Health Service. So why wouldn’t we operate an opt out scheme if it meant a better quality of life for many people?

If most people are donors, supply may exceed the demand for the organs. If this does occur, how do we distinguish between the organs which are donated? This would mean valuing one person’s body higher than someone else’s. In addition to this what would happen to the organs which are not used. Organ removal without the expressed wish from a deceased patient who hadn’t considered that they would need to ‘opt-out’ could be very distressing and upsetting for family members too.

Subsequently, it’s said that most recipients would prefer their donated organs to come from someone who had made a deliberate decision to donate. However, all statistics indicate that many more people are prepared to donate their organs after death than are registered as potential donors. With this new system, it saves people from the inconvenience of having to register, as they are automatically put forward for organ donation. Those who have strong opinions still do have the option to opt out, and will be made easy to do so, however it is slightly inconvenient, which may sway people to not do it, meaning more organs for the NHS, meaning more lives can be saved. Therefore an opt out policy should be enforced.

Another argument against Opt out schemes is that the pressure from society/positive stigma associated with organ donation may deter people from choosing to opt out even if this was their wish. If they were made to feel selfish this may put people off expressing their right to choose what happens to their body. It creates social tensions example, if a terminally ill person opts-out they may be made to feel selfish; highlighting a sudden inadequacy of right to refuse. This is unfair. A person should have the right to decide what happens to their body, whether it be for the greater good or not. Therefore an Opt out system is highly unethical.

An argument for opt out organ donation, is that a dead body is an inanimate object and has no use. Although it may hold sentimental value, once somebody has died, they do not longer require their working organs. If a person has viable and working organs when they decease, why would these be wasted? The dead body is incapable of feeling, thus there is no pain involved. Doctors are also competent to respect the cadaver’s body, meaning that the person would still be looked after, and receive good medical treatments, even when they’re deceased.

Another argument against the opt out system is that it could threaten individual rights in a number of ways, particularly with the conflict of interests between care of the dying and those waiting for organs in a way that the state could gain unwarranted control and ‘exploit’ donors. Moreover, there is fear that the new system could be misused, such that donation procedures could be implemented before patients are confirmed dead or that less effort will be made to keep patients alive if their organs could help younger patients awaiting transplantation and medical professionals may consequently hasten death. Along with fears that their bodies will be mutilated. This goes against the ethical law of non-maleficence. If an organ is removed before a person is pronounced dead, it harms the patient. (Automatic organ donation: The pros and Cons, 2016)

To counteract this, Doctors go through 5 years of intense medical training, before they start working as a Junior Doctor. This is an adequate amount of time for the people to learn and appreciate ethical laws, and become competent Doctors. It is extremely unlikely that a Doctor would ‘hasten death’. Therefore we should not worry about the ability of our Doctors, as they are fully aware of medical laws and know the consequences of not acting in the best interests of the patient.

To conclude, I believe that the UK should not change to an opt out system. In an ideal situation individuals should make a positive choice to donate tissues or organs after their death for the benefit of others without coercion or manipulation. I also feel that donating your organs after death is a valiant thing to do; if everyone were to donate their organs it wouldn’t be as much of a good deed, therefore possibly increasing the number of people who would opt out, as it would be seen as devalued, and pointless. Therefore I think we should keep the current system, however we should raise the awareness of organ donation, as the benefits from it are really important within the health service.



Automatic organ donation: The pros and cons (2016, 12 ,8) Retrieved from the Week:

English, V Sommerville A Presumed consent for transplantation: a dead issue after Alder Hey? A journal of Medical Ethics 2003;29:147-152

BMA, Building on Progress: Where next for organ donation policy in the UK?‟ (February 2012, BMA Medical Ethics Committee) 69.

Glannon W Do the sick have a right to cadaveric organs? Journal of Medical Ethics 2003;29:153-156.

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