Letter: Opt-out requirement for organ transplants

Sir: Tom Sackville resists the introduction of 'an 'opt-out' system by which surgeons would have the right to remove any part of the body they want', unless the patient has forbidden it (Letters, 5 February). He gives the pragmatic reason that the system does not work. A more serious objection is that the public is largely unaware that surgeons may operate for the harvesting of organs for transplantation before the patient would be regarded as dead for any other purpose.

Even some nurses and medical staff remain unaware that, in the UK, it is only necessary for some of the brain-stem functions to be tested and found to be absent for the patient to be declared dead. A recent paper from the United States, where some testing of the higher parts of the brain also is required, concludes that 'patients who meet the current operational criteria for brain death do not necessarily have the irreversible loss of all functions of the entire brain'.

It is still commonly assumed that life-support is withdrawn before surgery for the removal of organs begins. In fact, protocols require these 'beating-heart donors' to continue to be intensively treated, no longer for their own benefit but in order to keep their organs in optimum condition for transplantation, and later to be given paralysing and anaesthetic drugs for surgery to take place.

Information about these conflicting views of death should always be given to potential donors or their relatives when consent is sought, and included on donor cards (which it is not), for such consent to be valid. The price of truth may be more refusals. One advantage of an 'opting-out' system would be that such explanations, although rarely given now, could more easily be avoided.

Yours faithfully,

DAVID HILL

Consultant Anaesthetist

Addenbrooke's Hospital

Cambridge