MSPs should reject flawed organ donation Bill

25th Feb 2019 - James Mildred

MSPs should reject the Scottish Government’s proposals to introduce a new organ donation system of ‘deemed consent’, according to the charity CARE for Scotland.

The Human Tissue (Authorisation) (Scotland) Bill will be debated at stage 1 today (Tuesday, 26 February), following scrutiny by Holyrood’s Health and Sport Committee.

Under the plans, the current ‘opt-in’ system of organ donation, where donors voluntarily choose to gift their organs upon death, will be replaced by a controversial ‘opt-out’ system, where the State will presume people want to donate, unless they specifically choose not to.

During committee stage, CARE for Scotland provided both written and oral evidence on both ethical and practical reasons to reject the Bill.

The charity’s policy officer, Dr Gordon Macdonald told the committee back in December that evidence from other countries suggests an opt-out system is not guaranteed to work.

The most successful country when it comes to organ donation, Spain, has rejected claims it operates an ‘opt-out’ system with experts there suggesting the record donor levels are the result of awareness campaigns encouraging people to donate and the funding of training for medical professionals in procedures regarding organ donation.

Crucially, the Nuffield Council on Bioethics in 2017 found that the presence of specialist organ donation nurses helps increase the donation rate from 27.5% when they are not involved, to 68.6% when they are.

Instead of spending resources on shifting to an opt-out system, which will require a costly publicity campaign to ensure consent is truly informed, CARE for Scotland is calling on MSPs to make sure money is spent on more specialist organ donation nurses in every hospital across Scotland.

CARE for Scotland’s Parliamentary Officer, Dr Gordon Macdonald said:

“For anyone waiting for an organ donation, it can be a very distressing time, not knowing when or if an organ will become available so it’s absolutely critical that raising organ donor levels is done in a way that’s proven to work.

“Far too much of the debate so far seems to have been dominated by this naïve belief that the ethically troubling opt-out system will automatically see an increase in donor levels. 

“Actually, when you look at the international evidence, the situation is a lot more complicated and it would be a big mistake to think this new system is some sort of ‘silver bullet’ that will lead to an automatic increase.

“If you look at Wales, it’s not clear yet that the shift to an ‘opt-out’ system has made a significant difference and in other places, like Spain, they are clear that the record levels of donors has nothing to do with ‘deemed consent’ at all.

“Scotland has been leading the way in persuading people to become donors under the current ‘opt-in’ system so it seems frankly bizarre that there is this rash desire to rush ahead with this costly change, without properly engaging with the evidence.

“When the Nuffield Council on Bioethics looked into effective ways of increasing organ donor levels, they found that increasing the number of specialist organ donation nurses had a clear and positive impact.

“Instead of spending millions of tax payers money on ‘deemed consent’, the Scottish Government should be looking to increase the number of specialist organ donation nurses.

“Not only are there no ethical concerns around this approach, it’s actually proven to work.”


Notes to editors:

For more information / interview requests, please contact James Mildred: // 07717516814

CARE for Scotland gave evidence on the new organ donation system to the Health and Sport Committee:

CARE’s Director of Parliamentary Affairs, Dr Dan Boucher previously spoke to BBC Radio Scotland explaining why an opt-out system does not lead to an increase in organ donor levels: 

In an article for the British Medical Journal written by leading organ donation experts Prof John Fabre, Paul Murphy and Rafael Matesanz, explain why, when it comes to assessing Spain’s organ donor levels, ‘presumed consent’ is a distraction: Entitled ‘Presumed consent: a distraction in the quest for increasing rates of organ donation,’ the article states: ‘Crucially, Spain does not have an opt-out register for those who do not wish to become organ donors. Not a penny is spent on recording objections to organ donation by Spanish citizens, nor on public awareness of the 1979 legislation.’  -    BMJ 2010;341:c4973.

The Nuffield Council on Bioethics has called for a more robust discussion about the evidence before changes to opt-out were considered:

In December 2017, a study confirmed that Wales’ opt-out system had not increased donors:

Despite misgivings about an opt-out system, CARE is not opposed to organ donation and in September 2018, to coincide with Organ Donation Week, CARE ran a week-long campaign to raise awareness about the importance of organ donation:


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