Can the dead be selfish?
Is it wrong to want to keep our bodies blemish and scar-free, and with everything intact even after we’ve stopped using them? And with Australia’s comparatively low organ and tissue donation rates, is it time we changed our current system?
What Australia does
Australia operates under an “opt-in” model of consent, where unless an individual specifies that they wish to donate their organs and tissue after death, they will not be used as a donor. Regardless of whether they’ve signed up to the national donation register or not, the next of kin will also be asked to give consent to go ahead with donation. They have the right to say no, overturning a person’s wishes. Some countries, most notably Spain, uses “presumed consent”, the opposite of the Australian process. An individual must say that they do not wish to donate, otherwise their organs and tissue will be donated. Even in this situation the next of kin still have the final say.
The case for
Australia has long had few donors for our many millions. In 2000 there were 10.8 donors per million population (dpmp), rising to a high of 15.6 in 2012. Victoria has also has a rocky ride, with donation rates falling from 19.3 in 2011 to 16.3 dpmp in 2012. In 2009, the federal government announced industry-wide reforms, including millions of dollars in funding, widespread staff training and a major public awareness campaign. While early progress on organ and tissue donation rates was made, rates have since stalled, hovering around the 15 mark. And only one per cent of all deaths occur under the circumstances needed for organs and tissues to be viable for donation, making the donation pool even smaller than it already is.
The good
More than 80 per cent of Australians say they support organ and tissue donation and would consent to their bodies being donated. A 2009 British Medical Journal study looked at donation rates across countries before and after the introduction of presumed consent. The results showed rates of donation increased after opt-out systems were introduced. Spain, who has had an opt-out system for more than three decades, has the world’s highest rate of organ and tissue donation, at around 35 dpmp.
The bad
Presumed consent has been criticised as taking advantage of people’s ignorance around the donation process. As with many Australians who say they haven’t bothered to register their wish to be a donor, equally people might not register their wish to not be one. Austria’s system in particular is considered “hard” as it does not allow relatives of the deceased to make the final decision regarding donation. Vocal opponents in Wales have described the move as “treating people like cars” to be stripped of parts, and warned that it will only take a few mistakes for the system to break down, and the organs and tissue of people who did not want to be donors to be mistakenly used.
Support?
Wales has just passed legislation to introduce an “opt-out” consent system, beginning in 2015. The UK is currently reviewing its consent system. A 2012 Victorian Parliamentary inquiry toed a similar government line, showing little enthusiasm for a move to change the Australian system. Their findings stated they believed high rates of donations “can be attributed to a range of factors including: reforms to the hospital sector, improvements to transplantation services and increase community awareness”. Most of the submissions to the inquiry by Australian organ and tissue donation groups said they were unsure presumed consent would work, as there was little evidence to back up the correlation between it and higher rates. The Catholic Church of Melbourne has also said it will not support presumed consent, and wants to remove the provision that allows a “designated officer to give consent in the absence of being able to contact the family of the dying patient”. However Transplant Australia supported the proposal, saying it can “play an important role in helping a country’s population better understand that the natural decision to make when a loved one dies is to donate their organs”.
For more media related to the presumed consent debate in Australia, visit:
Four Corners – “A Gracious Gift” April 8, 2013
Triple J: Hack – “Donating your organs” February 21, 2012
