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'Opt-out' organ system becomes law in Wales


A new law creating the first opt-opt organ donation system in the UK is to be rubber-stamped at a special ceremony on September 10.

The Human Transplantation (Wales) Bill was overwhelmingly passed by Welsh Assembly Members earlier this year - with ministers saying it would drive up transplant rates and save lives.

First Minister of Wales Carwyn Jones will perform the official sealing ceremony to mark the final stage in the passing of the Bill before it is given Royal Assent.

It is also expected that details of when the new law will come into effect will be announced.

The Welsh Government has long said there is a desperate need to drive up transplantation rates - with 226 people in Wales waiting for a transplant.

Officials hope the new legislation will increase donors by around a quarter.

Once implemented, people will have to choose not to donate their organs and it would apply to over-18s who die in Wales if they have lived in the country for more than 12 months.

Organs made available under the system would be the same as the “opt-in” method - including kidneys, heart, liver, lungs and pancreas - and would not only go to donor patients in Wales. They could go anywhere in the UK.

The scheme faced opposition from some religious groups, which claimed it would make conscripts out of donors.

But ministers have denied this and described the system as a “soft opt-out”.

They say it will allow relatives or “friends of long standing” to object to someone’s organs being used if they had not asked to be removed from the register. The final decision will rest with medical staff if they decide to continue with the process - provided a match has been found.

No organs donated in Wales under this method will go anywhere else in the UK and vice-versa.

Health minister Mark Drakeford described the new law as historic.

“I am proud that Wales will be the first nation in the UK to take this step,” he said.

“Family refusal is a major factor that affects the numbers of organ donations and the main reason for refusal is lack of knowledge of their loved one’s wishes.

“The family of the potential donor has a major role to play in organ donation. The aim of the Bill has always been to respect the wishes of the deceased. However, relatives or friends of long standing may object to consent being deemed based on what they know about the views of the deceased.

“When family members know that organ donation is what the deceased would have wanted, they usually agree to participate in the donation process.

“The new law will work by clarifying people’s wishes around the issue of organ donation and, in turn, increase the rate of consent to donation.”

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Readers' comments (8)

  • I wonder how much public discussion has been done on this and how detailed the explanation of the process has been.
    Have they (those who made the arbitrary decision to opt out) for instance explained the process of organ retrieval and that the donor is not deemed to be alive in the true sense and therefore does not require an anaesthetic.
    The tests they use to declare brain stem death are decades old and have never been reviewed. It has also been shown that some people thought to have been brain death have in rare cases made a recovery and have been able to recall some awareness of surroundings while in a state of deep coma.
    I have sadly had reservations about donation (and cannot reconcile my feelings) ever since watching this organ harvest procedure (on an elderly stroke pt) as a student nurse (which I now regret doing) in which I observed BP changes and then reading multiple articles in anaesthesia publications in which several senior consultant anaesthetists had said they could not be certain that the donor could not feel pain.
    It may be that in the case of severe open and therefore observable brain trauma it would be easier for relatives to accept the death of a loved one but what about those who suffer closed brain trauma eg ruptured aneurysm/stroke. How would the person agreeing to donation feel if they were to later find out that their loved one had for all intent/purpose been "gutted" without benefit of anaesthesia.
    Even though I know how desperate some people are for organs I am afraid if this duty fell to me I would feel bound to refuse permission unless I could be assured that an anaesthetic would be used.

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  • surely you are not taking the organs from living bodies who need anaesthesia?

    an opt in system is far more ethical as some such as the elderly or those with dementia or other communication problems and no family may not be in a position to opt out and others may have that decision made on their behalf by somebody with power of attorney.

    for others, hopefully they will be offered very clear options to allow them to opt out if the wish to do so.

    very sick patients who hope to recover may live in fear if they have not opted out that their death will be eagerly awaited instead of assisting them in their fight for life. imagine recovering from serious illness only to discover you are minus organs!

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  • my god, i have a welsh christian and surname, although I have never lived in wales. if i visit there am i at risk?

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  • I am a nurse of . 16 years.There is something about the word "harvest" in this context which has always made me feel very uncomfortable - gives me the creeps would be more accurate. I now feel even less comfortable.

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  • On the other hand is it fair in any responsible society that those who choose to opt out of donation should themselves be the recipients of organs if they were to need them??

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  • if you opt out there is no guarantee you are protected. much safer to opt in to such a system. it should not be taken for granted that organs are there for the taking.

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  • may ethicists worldwide are against this opt out system.

    possibly to make it slightly more ethical/acceptable every citizen should be asked whether they wish to opt out of any scheme, including the one about sharing patient data or passing on medical notes. it should not just be left to chance in the hopes the person may come forward as there will be some who are not in a position to do so for a wide variety of reasons but nevertheless may wish to opt out. this could be a costly and impractical exercise and there is no guarantee that the opt out will be recorded or respected.

    how can such a scheme and those running it and involved in it ever be trusted?

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  • I think for family to have total confidence in doctors in situations like this, there needs to be greater public awareness of exactly what the brain stem death testing entails and loved need to be assured that every possible test that could establish any signs of life has been done and that there is absolutely no evidence of any brain activity.
    If an EEG is done then a recording of a close familiar voice should be played to the patient to see if this stimulates any activity.

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