Ms English
Deputy Head of Medical Ethics BMA

Dear Ms English

The Alliance consists of a number of medical organisations based on World Faiths and Hippocratic groups.It is a lay and informed body of mainly doctors.

Within such a diverse organisation there are different approaches to transplantation. There is however a strong view that it represents a generous act which must be voluntary. To safeguard the voluntariness , consent given in writing and in advance by the donor himself/herself is necessarily required.

The question of "opt in " versus "opt out" must therefore be measured not against the number of organs available and possible recipients ,but whether the present voluntariness will be undermined by possible changes. The so called "soft option" in your paper ,may not be practical or effective. Relatives under stress cannot be a substitute for a decision made by a donor in calm reflection. Furthemore relatives may not be found at the time required, or they may not have knowledge of the donor`s wishes.

You touch upon the question ,which is fundamental to transplantation , of brain stem death. As you know this criterion is not used in most other
European countries or the United States.

For many brain stem death critria surffice but there are those ,and the number is likely to increase ,who do not accept that death has taken place whilst the heart is still beating spontaneously ,and only part of the brain is not functioning.

A change in the law towards "opt out " as the present "opt in" will not help communities with a strong ethnic or religious sense and could be experienced as discrimination.

The present system of voluntary donation may indeed be improved upon ,but a change to presumed consent is a step too far. It would create anguish nand distress not least for the medical and nursing staff in ITU and elsewhere who would have to put it into effect. Most families will not ,whatever the publicity , be prepared for it.

Medical Ethics Alliance
14/3/00