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Organ donation: Ours to give

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Politicians still seem a way from trusting citizens and the medical profession with the issue of voluntary euthanasia, but they are, finally, reviewing our shameful inertia on organ donation.

Many of us may think we have voluntarily assigned our organs for potential transplant, but in practice we have mostly been wasting our time. The organ donor declarations we make on our driver licences do not constitute legally enforceable consent. Thus they seldom lead to donations because they give doctors no authority to take organs.

It is well known and widely resented that this and any other formal expression of donor willingness can be summarily overridden by one’s family. This is patently wrong and at odds with the legal status accorded to “do not resuscitate” orders.

The Government at last agrees. Health Minister Jonathan Coleman says it will reform the law and consent procedures to facilitate organ donation after it has reviewed the results of a consultation process announced this month.

At a minimum, the new law must revoke family veto rights. But further, given the continual demand for organ transplants, we must at least consider the world-leading practice of presumed consent. The countries with the best organ donation and transplant rates deem all people’s bodies available for organ harvest, unless they have opted out in life. Our organ donation rate is around 10 per million of population, lower than Australia’s 16 and dwarfed by Spain’s 36. Last year only 46 organ harvests were carried out here

Seven hundred people are on the waiting list for new kidneys. Many will die while waiting, although a kidney match could probably be found for them if we operated a functional donation system. This is deeply regrettable, particularly considering the clear willingness of New Zealanders to donate organs after death.

The driver licensing system is not even a de facto register of organ donors, but 53% of licence-holders have indicated their willingness to donate. That’s 1.7 million people.

Clearly posthumous organ donation is not a decision to be made casually, and we have erred badly in relegating it to the New Zealand Transport Agency via an arbitrary and unrelated licensing system. The review will consider better options, including the establishment of a formal register of donors.

As it must, the review will also explore religious and cultural objections to organ donation. No one would seek to deny the rights of those who believe body parts are sacred and there is no question anyone will become a donor against their will. But the emphasis needs to be on personal choice.

An unhelpful contribution to this debate came from a biomedical ethics expert, University of Otago’s Professor Grant Gillett, who blamed the Government and ministry’s “neo-liberal individualism” for encouraging people to disregard their duties to others. The driver-licensing statistics suggest otherwise. As the present law and practice stands, the collective will of a would-be donor’s family is being allowed to prevail over the will of the individual.

We have, furthermore, put a terrible burden on families to make this decision at a loved one’s death bed. It’s tough on doctors to be expected to press the issue then and it is small wonder that they generally do not.

And yet donation can give great consolation to the bereaved, as the family of Michael Boyes attested after the 25-year-old’s sudden death in February from a brain aneurysm: they had heard him talk about wanting to be a donor, agreed to it and were comforted to learn no fewer than seven patients had benefited from his bequest.

Presumed consent is not the only factor for the far superior organ transplant rates in Spain, Croatia and the other world leaders in this field, but logic suggests it is the critical one. The policy must be backed by sufficient public information and engagement, and by adequate funding of hospitals to support the additional costs of more harvest and transplant procedures. A related proposal with Government support is Wellington MP Chris Bishop’s private members’ bill to provide greater financial support for those courageous and generous people who make live organ donations.

Any organ donation is a precious gift. It is clearly a decision best made by each of us for ourselves, outside the fraught atmosphere of illness, accident and death. It should be viewed in the light of the life it can bring to others – the warm glow of hope.

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