Life or death decisions

PUBLISHED : Thursday, 16 October, 2008, 12:00am
UPDATED : Thursday, 16 October, 2008, 12:00am

Twenty-one-year-old Holly Shaw spends three hours a day, three days a week having dialysis in hospital. The student at Britain's Chester University was diagnosed with renal failure three years ago and was put on the waiting list for a kidney transplant.

Holly is one of more than 9,000 people in Britain who are waiting for organs which could save their lives. While the dialysis keeps Holly alive, 1,000 patients in Britain die every year because there were no organs available for them.

In Britain only 13 people in every million donate their organs. That is a relatively low figure among European countries but is already three times higher than that of Hong Kong. Last year only 58 patients on the 1,500-long waiting list received a kidney transplant in the city. One of them had been waiting for as long as 24 years.

Organ donation has been promoted by governments and charities for decades, yet it is difficult to get people to commit to giving their organs. It is also difficult to get grieving families to agree to give up their loved one's organs.

Last month British Prime Minister Gordon Brown suggested the nation shift to a 'presumed consent' system in which individuals are automatically considered donors after death unless they choose to opt out of the system by registration.

This is in sharp contrast to the current system of expressed consent - as exists in Hong Kong - in which only those who have previously signed an organ donation card or whose family agree to donate their organs can be regarded as donors.

The major problem of the expressed consent system is the low registration rate of donors. Death is a topic that people avoid. Many people who fully support organ donation do not take the initiative to sign a donation card. When death occurs, devastated families tend to preserve the bodies of their loved ones.

However, presumed consent sweeps away the barriers and makes everyone a donor. Doctors are allowed to remove the patient's organs right after death unless the opt-out registration has been signed.

The system has been adopted in several countries. Spain, which passed a presumed consent law in 1979, has the highest donation rate in the world at 35 in every 1 million people. In Austria which has a donation rate of 26 per million, hospitals can remove dead patients' organs even if the family object. Only 2 per cent of Singaporeans have chosen to opt out, although they are automatically considered organ donors when they reach 18.

But those against the system argue it goes against a person's rights. A government cannot presume every single one of its citizen agrees to be an organ donor - after all it is a very personal decision. There is always a chance people who do not want to donate their organs have not applied to opt out.

There is also some concern the idea of having a possible donor on the table may influence doctors' decisions on when to stop treatment on patients who are dying.

The key issue is whether the government or the family owns the body after a person dies. There are dangers in a system where a body becomes a national asset that can be abused.

Presumed consent may not be the ultimate solution to the organ shortage, but in a situation where there is an acute shortage of organs, it will help save more lives. Before the Hong Kong government makes any move to change the current situation, signing an organ donation card would make a difference.