Ominous situation in Wales

There is an increasingly ominous situation developing in Wales with regard to the removal of organs and any other relevant material from our bodies after death without our informed consent.

All credit to Mr Darren Millar and Mr William Graham on the Welsh Assembly Government’s Health and Social Care Committee who opposed the introduction of a system of “deemed consent” for these removals. Unfortunately the rest of the Committee voted in favour and their majority report will be part of a debate in a plenary Assembly session on April 16th on the Human Transplantation (Wales) Bill.

The key points that have emerged to date are:

a) Deemed/presumed/inferred consent achieves a low ethical standard and it is a fictitious consent. It is culturally wrong for Wales – a country with a strong history of respect for autonomy.

b) The deceased organ donation rates in Wales have been increasing and higher than the UK average in eight of the past ten years. The preliminary figures for deceased organ donation rates during the 2012/13 year show an overall increase in the UK. It is good news that more people are making genuine donations through informed consent.

However in Wales the preliminary figures show a reduction in rates which might be due to year to year variations. The reduction might also be related to potential donors and their families being deterred from donating due to fears about the government’s threatening plans for deemed consent.

c) Spain does not operate a presumed consent system. This fact was confirmed by Dr Rafael Matesanz, Director of the Spanish National Transplant Organization. It is misleading of the Assembly Government to cite Spain to support their Bill.

d) There is a not a shortage of organs in the United Kingdom; there are systemic problems linking voluntary donations of organs with recipients. Wales has a lower critical care capacity than many other western European countries and this weakness contributes to the problems linking voluntary donations to recipients.

e) There are serious inconsistencies between the Bill, Explanatory Memorandum, and statements by the previous Welsh Health Minister regarding the involvement of families. There is a high risk that enactment will enable NHS management to pressurise hospital staff to take brain deceased or circulatory deceased patients for organ removal surgery without the support of the patients’ families. This situation will be deleterious to health care.

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About Iain Robbe

I am a medical practitioner (MB, BS, 1980; MRCS, LRCP, 1980) registered with the General Medical Council of the United Kingdom without a licence to practise. I am active as a Clinical Medical Educationist participating in a number of projects with the universities of St Mary's and Dalhousie in Nova Scotia and Mount Allison in New Brunswick, inter alia, and separately with three of the veterinary schools in the UK. My focus is on teaching and research in professionalism, ethics, and communications, and particularly the influences of vernacular architecture on the creation of positive learning experiences in undergraduate and postgraduate medical education. I have the degree of Master in Public Health from the University of London (1985) and the degree of Master in Medical Education with distinction from the University of Wales (2001). The guiding principles in my practices are based on andragogy and humanism, and the prime ethical principle of autonomy for the individual and in population health.

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