Abstract
When we look back at the period 2007–2008 in future years, the level of activity around organ donation issues will be striking. In January 2008, the Organ Donation Taskforce produced its report within which it claimed that organ donation rates could be increased by 50% within five years if its 14 recommendations were acted upon. 1 The Government has since given its full support to the Taskforce's recommendations and Sir Bruce Keogh, Medical Director of the NHS, has been asked to chair an implementation group. At the same time, Mr Chris Rudge has been seconded from his post as Managing Director at UK Transplant to become the newest NHS Csar with responsibility for transplant issues.
The work of the Taskforce has now entered a second phase, as it has been asked to consider the issue of presumed consent to organ donation in light of Sir Liam Donaldson, Chief Medical Officer for England's, support for a change to an opt out system – a position supported for many years by the BMA. This work is ongoing as the journal goes to press. The Taskforce has made it clear that transplantation needs to be seen as a UK-wide service, so it is important to acknowledge what is happening across the UK. In Wales, The Health Wellbeing and Local Government Committee is carrying out an enquiry which will be informed by a public forum discussion hosted on the National Assembly for Wales website. 2 In Scotland, MPs fell short of changing the law to allow for presumed consent back in 2006 when voting on the Human Tissue (Scotland )Bill, but the Act now passed removes the right of relatives to veto the wishes of potential donors.
Meanwhile, the European Commission has also been addressing organ donation 3 and, as a result, the House of Lords' Select Committee of the European Union (Sub Committee G) has been hearing evidence from experts on the extent to which a European Directive on organ safety and related issues would be welcome. 4
One of the issues that has emerged clearly from the deliberations of each of these bodies is the fact that one of the impediments to increasing donation rates has been, and will possibly continue to be, the ethical concerns of the practitioners, most obviously those working within the intensive care setting who are most often the professionals caring for potential donors and their families. Because of this, one of the Taskforce's proposals is that there should be an organ donation ethics committee to consider the ongoing issues raised by donation. Readers will have their own views on the merit of this suggestion, but in the meantime, we would hope that contributors to this journal will participate in the national debate that clearly needs to take place on many issues relating to organ donation.
We are keen to consider the views among clinicians and other interested parties on the possible implications of changing the basis for consent to organ donation. We would be interested to return to the issue of directed donation as covered in a previous Virtual Ethics Committee discussion in this journal 5 and highlighted in April 2008 by the case of Laura Ashworth and Rachel Leake, where a mother could not benefit from her daughter's postmortem donation. We would encourage clinicians to rehearse within the pages of this journal the presentation of issues and questions they might want to be considered by any ethical review body to emerge in future.
As a country we can take little pride in our statistics relating to organ donation. In cross-European comparisons we appear close to the bottom of the tables, with our donation rates comparing very unfavourably to those of Spain, the champion in Europe in terms of organ donation. If you are a member of a minority ethnic group, the situation is even more serious, as evidence suggests high levels of need coupled with low levels of donation within certain groups. In short we would like to be proactive in encouraging our readers and contributors to engage with the issue of organ donation so that 2008 will indeed be seen as the year in which things really started to change.
Looking now at the current issue, the second issue of Volume Three, we include another paper in our occasional series about how work on ethical issues is carried out in various institutions and organizations. Julian Sheather gives us an interesting and useful insight into the work of the British Medical Association's Ethics Committee, highlighting the degree to which the work of the committee has become increasingly complex and diverse as it responds to changes and innovations in both law and medical practice.
This issue also sees the introduction of another new occasional series, ‘Why I wrote…’, in which we ask the authors of recent books, or ‘classic’ texts relating to ethics and law as it pertains to clinical practice, to give readers an insight into what prompted them to write the book, what it contains and which publications of a similar nature readers might like to read. Penney Lewis, Professor of Law at The Centre of Medical Law and Ethics, King's College London, has kicked off the series on why she wrote Assisted Dying and Legal Change. We hope that this will make a practical and interesting alternative to the conventional book reviews often seen in journals such as this.