Organ donation now on the agenda in Northern Ireland

Wales has finally passed controversial legislation to bring in presumed consent for organ donation by 2015. Now it seems that Northern Ireland may be next in line to change their law on donation.

Currently in Northern Ireland (as in the rest of the UK, other than Wales) there is an ‘express consent’ system for donation after death. This means that doctors can only remove organs from adults who have expressly given their consent to donate their organs after death. However plans are now well underway to introduce a Bill to the Northern Ireland Assembly that would create a system of ‘presumed’ consent for organ donation.

In advance of a new Bill, an MLA (Member of the Legislative Assembly), Jo Anne Dobson has initiated a public consultation to encourage feedback on her proposed bill.

As brief background, in Northern Ireland there are on average 15 deaths each year as a result of the shortage of organs. There is clearly a pressing need to invest more in organ donation. However, although it is important to increase organ donation, there are concerns that changing the current system, where consent to donation has to be specifically given, to one where it is simply presumed, is ethically unsound.  There is also evidence to suggest that ‘presuming’ consent doesn’t work in practice and has even been counter-productive in some countries. There are already several blogs on this issue  on the CMF website, highlighting our concerns with ‘presumed consent’ (for example, see here and here). These are written in a personal capacity. The CMF response to the Welsh consultation on organ donation is here.

The online consultation by Jo-Anne Dobson MLA provides an opportunity for the public to begin to engage with this issue in Northern Ireland.  A briefing paper produced by CARE (available here) supports increased organ donation but not through introducing presumed consent. It also notes alternative options of ‘prompted choice’ or, more controversially, ‘mandated choice’.

A form of ‘prompted choice’ is already in use in England and Wales (but not Northern Ireland) when applying for a driving licence. Anyone who has applied for a new driving licence, or renewed one online, since August 2011 will have answered a question about organ donation. The well-intentioned purpose is to prompt people to make a choice about signing up to the organ donor register. Unlike in England and Wales, this question remains a voluntary one in Northern Ireland when applying for a driving licence.

‘Mandated choice’ would force people, by law, to decide whether they wish to be donors on death or not.  This would have to involve the use of some sort of punishment or penalties if an adult fails to make a choice, or refuses to. There limited evidence of its effectiveness and even the BMA has expressed concern about the coercive nature of forcing people to make a decision at a particular time.

If you would like to engage with the online consultation, it can be found here. The original deadline of 10 September has now been extended to 24 September. If pushed for time you could just answer question two which will only take a couple of minutes.

It seems that now Wales has passed presumed consent legislation, we are going to see the same debates in Northern Ireland and then Scotland, and perhaps England too. This is an issue and debate that is not going away and will one day affect far more than Wales and Northern Ireland.

Posted by Philippa Taylor

CMF Head of Public Policy