Theresa May’s plan to make organ donations automatic by 2020 is doomed to failure, according to new research.
The controversial ‘opt-out’ register is unlikely to increase the number of organs donated for life-saving transplants and could possibly even lead to a reduction.
This is because families still have the final say and presuming consent means they are much less likely to think this is what their loved ones would have wanted.
Instead, donors should be encouraged to actively choose to ‘opt-in’ to ensure they genuinely wish to donate their organs, say scientists.
Three studies involving almost 1,300 US and European men and women aged 18 to 72 showed a donor’s underlying wish to donate was perceived to be stronger if they had done this.
Lead author Dr Magda Osman, from Queen Mary University of London, said: “We show it’s harder to judge the underlying wishes of the deceased if they were on an opt-out and mandatory donation register.
“Why? Because making a free choice indicates what your preference is. If you don’t actively choose and you are listed as a donor on the register, then it isn’t clear if you really wanted to donate your organs.
“This matters because if in the event of death your relatives have to decide what to do, they may veto the organ donation if they can’t tell for sure what your underlying wishes were.”
Organ donation will be made automatic under plans backed by the Government in a move which ministers believe could save 200 extra lives every year.
People will have to opt-out of having their organs donated when they pass away under the terms of a presumed consent scheme.
The proposals brought forward by backbench Labour MP Geoffrey Robinson have won the support of the Prime Minister and Jeremy Corbyn which means they will almost certainly become law.
But the opt-out register is unlikely to increase the number of donations, says the team.
Co-author Dr Yiling Lin said: “There are plans to launch an opt-out organ donation system in England.
“But what we show is this system is unlikely to increase actual rates of organ donation or reduce veto rates. All it will do is increase the number of people on the organ donation register.”
The findings published in the Journal of Experimental Psychology: Applied back evidence from Wales where an opt-out system was introduced in December 2015.
This has actually led to a small dip in the number of deceased donors – from 64 in 2015-16 to 61 in 2016-17. This resulted in a drop in organ transplants from 214 to 187 respectively.
An opt-out system automatically registers everyone and presumes consent to donate. If you do not want to you must take yourself off the list. But it includes a clause where relatives can object.
An opt-in system requires explicit consent to donate and indicates willingness.
NHS Blood and Transplant reported in 2016 that more than 500 families vetoed organ donations since April 2010 despite being informed their relative was on the opt-in NHS Organ Donation Register.
This translated into an estimated 1,200 people missing out on potential life-saving transplants.
The opt-out system is expected to be introduced in England by 2020. The researchers say this will create ambiguity and will not reduce veto rates.
All study participants were from countries that have either a default opt-in or default opt-out system.
They were presented with a fictional scenario and asked to take on the role of a third party to judge the likelihood that an individual’s ‘true wish’ was to actually donate their organs – given that they were registered to donate.
Overall, regardless of which country the participants came from, they perceived the donor’s underlying preference to donate as stronger under the default opt-in and mandated choice systems as compared to the default opt-out and mandatory donor systems.
In 2017/18 there were 6,044 people in the UK waiting for a transplant while 411 patients died while waiting on this list.
Similarly, this year in the US there are 114,000 people on the waiting list to receive an organ and it is estimated that 20 people die each day while waiting on the list.
Dr Osman said: “To help increase actual rates of organ donation, we need more transplant coordinators working with families to help them understand the issues before being faced with a monumental and distressing decision.
“We also need to offer people a way to indicate explicitly what they wish to do. This should involve an expressed statement of intention if their wish is to donate, or an expressed statement of intention if there is an objection to donate.
“This reduces the ambiguity in trying to infer what one wanted to do when it comes to donating their organs.”
