You know a policy is a corker if you agree with Jeremy Hunt on it. After all, the man has continuously ran the NHS into the ground since he was appointed Health Secretary in 2012. Nevertheless, his proposal to institutionalise an opt-out organ donation should be commended. It may be the only policy of Hunt’s that may actually be effective. It will help the NHS and, arguably, the population of the UK as a whole.
Currently, the UK is operating on a opt-in basis for organ donations. The medical profession will assume that your body is not to be used for donations after your death unless you have explicitly stated your consent by signing up to the register. This policy is unpopular, largely because many people are not aware of the need or process for signing up to organ donation. Opt-out procedures, which assume consent to donation unless you sign the opposite, manipulate this to ensure a greater number of available organs.
People are lazy, they don’t enjoy having to sign up for organ donations, or having the uncomfortable conversations that accompany it.
Instead, an opt-out process would remove this need, meaning that people have to put in the effort to actively resist donations.
This policy is pragmatic, built on the awkward yet true knowledge that people are lazy and do not fill out health forms. Instead of having to put effort in to signing up, this policy removes any needed participation.
Simple and effective, this policy also has the additional benefit of indirectly shaming of those who do sign against donation, making it seem like they are going against the grain and not being a team player.
Wales, operating on an opt-out basis since December 2015, has found this blend of time-saving and shaming successful. Only 6% of the population have ‘opted out’ since the policy’s implementation, a miniscule amount compared to those who have not consented in the UK.
The policy has received cross-party support, endorsed formally by May, and is on its way to its second reading after passing the first in July 2017 with flying colours.
Of course, its not popular with everyone. Some question whether it really is anymore effective or even fundamentally any different than opt-in procedures.
The policy proposes the less extreme, ‘soft’ opt-out option whereby the deceased’s family still has to give consent to organ harvesting. As many of the pressures that stop people from opting-in to donating in the UK come from the family in the first place, it is likely that such a soft approach will be as unfruitful.
Instead, others advocate for a ‘hard’ approach to ensure that organ donations actually occur. Already in operation in Austria and Singapore, this approach does not take family wishes into consideration. Alternatively, Israel operates on a ‘priority incentive scheme’ whereby donors receive priority treatment if they themselves require organ transplants. Both attempt to more formally institutionalise and incentivise donations, as medical demand arguably necessitates.
Yet the ethical issues that come with ignoring the family and making donations into hierarchies cannot be ignored. It makes it unlikely that either policy will replace the softer approach that has been introduced.
If we want to tackle organ depletion, we need to start with the less extreme approach, to ensure it at least becomes the norm to be a donor. A small step, with some obvious limitations, but an crucial one nonetheless. Such a policy will help with encouraging BAEM groups – historically low contributing – to donate.
Of course, some religious and ethnic groups do not agree with transplants, as per their specific funeral rites. However, contrary to popular opinion, no major religious denomination expressly condemns transplants. Instead, the majority of the population are ambivalent towards donations; they are supportive but not active, at least not at signing up.
That is the true promise of this policy. It removes the need for agency on the part of the general population, who in mass amount support donations and will likely not ‘opt-out’. It also removes the need for people to talk about death and their plans for their bodies following it, which discourages many from signing up.
This policy truly is an innovative and pragmatic solution to the organ crisis in the UK. At the very least, it is placing the issue on the agenda, facilitating conversation, and hopefully normalising what should be a routine practice. At the very best, it will save lives – thousands of them.