Skip to main content

Organ and Tissue Donation (Mandated Choice)

Volume 507: debated on Wednesday 17 March 2010

Motion for leave to introduce a Bill (Standing Order No. 23)

I beg to move,

That leave be given to bring in a Bill to establish a system of mandated choice for the donation of organs and tissues; and for connected purposes.

It is a magnificent achievement that in 2008-09 there were more than 3,500 organ donations in the UK. In addition, more than 4,000 corneas were donated, leading to 2,711 people having their sight restored. Tragically, in the same year, more than 1,000 died an avoidable death while awaiting a life-saving organ transplant. I believe that we have a moral duty to reduce the number of avoidable deaths. The pertinent questions, therefore, are why we are allowing those deaths to occur and what we can do to change those sad statistics.

In a report published in January 2008, the organ donation taskforce identified several barriers that mean the UK is lagging behind other European countries when it comes to the number of transplants that take place. Further research published by NHS Blood and Transplant shows that four out of 10 families refuse the request for organ donation, even when a deceased relative has signed the organ donor register.

With just 27 per cent. of the UK population signed up to the register, the simple fact is that not enough people are saying yes to granting the gift of life through donation when they die. Surveys indicate that between 60 and 90 per cent. of the UK population support organ donation and personally want their organs to be used to save a life, so why is it that just 27 per cent. have given their explicit consent? What are the barriers, and why is that figure not nearer to the 60 to 90 per cent. mark? Do people intend to go online and register but forget to do so, or are they simply too busy? Do they even know that there is an online registration process? That line of questioning is endless.

One simple answer is that the current system needs to change. The opt-in system is voluntary and, by its nature, a barrier in itself, so the obvious question is: what are the alternatives? One is an opt-out system, whereby consent is assumed. Personal choice and the right to choose are fundamental in any personal decision. On organ donation, they should be paramount. A system that assumes consent therefore carries moral and ethical dilemmas that cannot and should not be ignored.

With an opt-out system, medical professionals treating a dying patient would be put in a difficult position. They must broach the subject with the family, who would be forced to consider the issue at what is always an emotional and traumatic time. There would be many instances when no discussion about organ donation had taken place, and the individual had not opted out. The medical professional must then approach the family to arrange organ donation in the absence of active consent by the potential donor. Inevitably, there will be circumstances in which the organs are used of an individual who opposes organ donation, but has failed to make his or her views known. Again, that raises serious ethical issues about personal choice and an individual’s right to choose whether they want their organs to be used after death.

I have worked closely with Mrs. Pat Hall from Lancashire, who has campaigned for many years to increase the number of people on the organ donor register. Pat lost her son in the early 1990s, shortly after the register came into force. He was on the register and had made his choice known to the family. He was able to help several people through organ donation. I have discussed the problem of presumed consent with Pat, and she explained that many campaigners were unhappy with it. She believes that individuals should make an active decision to donate.

Pat’s alternative is the mandated choice system, whereby every UK citizen would be required by law to make a declaration, one way or the other, about whether they wished their organs to be used after death. By offering the choice of saying yes or no, or leaving the decision to the family, a person’s civil liberties are protected. Mandated choice has been introduced in some countries, but the choice has been only between yes or no to organ donation. The Bill proposes a third choice—essentially what we have now—of leaving the decision to the family at the time of death. There is, therefore, a status quo option, which would make a difference by making it easier for people to accept the proposal.

The practicalities of a mandated choice system obviously need to be considered. Initially, every adult will need to be approached and asked to make a choice. It would then to be necessary to ensure that individuals are asked at certain points during their lives, such as when they receive a national insurance number or register with a GP, or possibly when they obtain a driving licence. When a person explicitly states their intentions, all doubts about their wishes—and thus the wishes of a dying patient—are removed. That safeguards health care professionals as they know exactly what their patient wants. It also removes the burden on the family when a relative dies.

Reforming the current opt-in system to a mandated choice system will increase the number of people registered as organ donors. By choosing to be an organ donor, we offer patients a second chance at life. I want a system that reduces the number of avoidable deaths to an absolute minimum and reduces waiting times for people who need life-saving transplants.

I am sure that we would all be prepared to accept an organ if we needed one to carry on living. If most are prepared to receive, I would expect most to be prepared to provide. Failing to reduce the number of avoidable deaths is a tragedy and, worse, a preventable tragedy. I present the Bill to introduce a mandated choice system as the best way in which to reduce the number of avoidable deaths. I hope that it will receive the support of the House.

I listened with great interest to the proposal for a mandated choice approach as outlined by the hon. Member for South Ribble (Mr. Borrow). I happen very much to agree with organ donation, and when I pass on, if there are any bits that are still usable, the state is perfectly welcome to them—[Interruption.] I will not be drawn by the hon. Member for Wolverhampton, South-West (Rob Marris).

However, my concern is that mandated choice will put people under moral pressure to acquiesce, even if they do not feel comfortable doing so. I am conscious that the hon. Member for South Ribble realises how sensitive the matter is and that very strong emotions can be generated, including for reasons of faith, especially at the time of death. I applaud his intent, but it is nevertheless my view that our society and culture are still at a stage at which there is insufficient buy-in to the concept of organ donation. In some ways, we do a disservice to our society if we do not work towards increasing the number of people who actively sign up.

I do not seek to press the matter to a Division, because that would be a bad use of time; I simply flag my concern that it is easy to codify such things in an administrative way, but we have some way to go as a society. I would prefer a mandatory development of an understanding of the options, without having the paperwork to go with that at this stage.

Question put (Standing Order No. 23) and agreed to.


That Mr. David S. Borrow, Jim Dobbin, Mr. Lindsay Hoyle, Mr. David Crausby, Bob Spink, Dr. Brian Iddon, Derek Twigg, Mr. Mark Hendrick and Geraldine Smith present the Bill.

Mr. David S. Borrow accordingly presented the Bill.

Bill read the First time; to be read a Second time on Friday 23 April, and to be printed (Bill 91 ).