The British Medical Association decided last week to continue to support the idea of presumed consent for organ donation - so it would be possible to take organs for transplantation from anyone who had not "opted out" of the system provided their families did not object. At present, organs are taken from people who have "opted in" by volunteering to join the Organ Donor Register. The Welsh Assembly is to consider legalising a presumed consent system for people in Wales.
Whenever I am asked to volunteer to become an organ donor, my reply is a definite No. I do not object to people donating their organs for use after their deaths if they wish to do so, but I am not willing to become an organ donor for two good reasons.
Up to the 1960s, the only criteria for diagnosing death were that breathing and heartbeat had irreversibly ceased.
In 1976, after ventilation had been developed to provide ongoing life support for brain-damaged patients, the conference of British Medical Royal Colleges decided that if a patient tested positive for death of the brain stem, then if life support were removed, the patient would be expected to die.
In 1979, when organs were beginning to be required for organ transplantation, the conference issued a statement saying that a patient who tested positive for death of the brain stem was dead already. Prognosis had become diagnosis.
A patient who tests positive for what has come to be known as brain-stem death will be breathing. His or her heart will be beating. Her body will be its normal colour, and warm. She can digest food, and given liquids, will urinate. If she is not turned regularly, she will develop bedsores. If she is young, she will come to sexual maturity. If she is pregnant, she can bring a baby to the point of birth. But the majority of doctors will say that she is already dead, and her organs can be taken for transplant.
(A leaflet for prospective organ donors published by the Department of Health says "Will I really be dead when they remove my organs? Yes.")
I do not believe that brain-stem death is in fact death. That is the first reason why I will not be an organ donor.
The second is this. Prospective organ donors and their next of kin are never told that the patient will still be breathing and his or her heart still beating when the organs are removed. (The only organs used for heart, liver and pancreas transplants are organs taken from patients whose hearts are still beating.)
Prospective donors and next of kin are led to believe that life support will be switched off and then the organs removed. This is not what happens. Any organs required will be removed, sometimes without anaesthetic, and then life support will be switched off.
For donors and next of kin not to be told that the patient will be breathing and the patient's heart still beating when the organs are removed is unethical and immoral.
