Church urges MSPs to exercise caution over organ donation plans

A reconstruction of Dr Christian Barnard's first human heart transplantation in Capetown, in December 1967, showing the meticulous counting of the sterile towels used at surgery. Photograph by Tiiu Sild.

The Church of Scotland has raised significant concerns about proposals to change the law on organ donation which would mean people would automatically be donors unless they stated otherwise.

The Rev Sally Foster-Fulton, convener of the Church and Society Council, said she and her colleagues did not think plans to amend the current "opt-in" system to a "soft opt-out" one were necessary.

She has set out the General Assembly of the Church of Scotland policy in a written submission to the Scottish Parliament's health and sport committee, which is considering the issue.

The Church fears the change would not result in the number of organs available increasing and could lead to inequality, a loss of trust between families and medical professionals and reduced public support for transplantation.

The law on organ donations in Wales is changing in December and Ms Foster-Fulton has told MSPs that the "best and most responsible" approach would be to properly assess the outcome before approving the Transplantation (Authorisation of Removal of Organs etc.) (Scotland) Bill.

The private member's bill brought forward by Labour MSP Anne McTaggart seeks to introduce a soft opt-out‖system which allows, in certain circumstances, for the removal of parts of a deceased adult's organs for the purposes of transplantation in the absence of express authorisation.

Under the Bill, it will still be possible for people to opt-in to organ donation, but it will also give adults resident in Scotland the options of appointing a proxy to make a decision about authorisation on their behalf, or to register in advance an objection to removal to opt out.

Ms Foster-Fulton said the Church of Scotland believed that the current legal position already accomplishes much of what the proposed legislation seeks to achieve.

"While being supportive of a desire to see an increase in tissue and organ donation in Scotland, we do not believe that the proposed legislation is necessary or represents the best way forward," she added.

"It is the view of the Church and Society Council that there is not yet evidence that such a change would necessarily significantly increase the number of organs available for transplantation."

"Between 2008 and 2013, 62% of all donations came from donors who were not on the donation register at the time of their death.

"In these cases, consent for donation was given by relatives (or, in some cases, close friends), many of whom may not have had clear prior knowledge of the views of the deceased with regard to tissue and/ or organ donation."

Ms Foster-Fulton said a Spanish- style "opt-out" system was already largely operating in Scotland.

"There is evidence to suggest that the better funding and regional organisation is more important in increasing donation rates than simply introducing presumed consent," she added.

Ms Foster-Fulton said a change to an "opt-out" policy has had detrimental effects on the number of organs retrieved for transplantation in other countries like Brazil and France.

"We consider that there is a risk of inequality in accessing the means of opting out of organ retrieval," she added.

"Some people will never want to address the concept of their death and therefore will not make a decision about organ donation.

"Some may not have the education, capacity or social circumstances needed to allow them to engage with health or legal organisations responsible for compiling the opt-out register.

"Those with learning difficulties, homeless people or mentally ill people are among the groups who may be, or who may perceive themselves to be, less able to opt out.

"There is therefore a danger that, in the long run, the pool of donors will be drawn disproportionately from the 'voiceless'."

Ms Foster-Fulton said the Church was concerned there was a risk of a loss of trust between families of critically ill patients and medical staff.

"There is a potential for harm to the bereaved, if they do not want organ donation to proceed, but feel that they cannot refuse in the absence of an opt-out order by the deceased," she added.

"If the family feel removed from decision making by the absence of an opt-out directive, then we can foresee distress and loss of trust which could be harmful to the bereaved and to medical teams alike."

The Church of Scotland is concerned that introducing an "opt-out" system could lead to cases where the bereaved family later resent the taking of organs and complain that their wishes were not considered or that they were pressurised into agreeing to organ retrieval.

"In the event of such cases being publicised, it may be that the general public becomes less supportive of the medical teams seen as the takers of the organs and perhaps even of the recipients of the organs," said Ms Foster-Fulton.

"The Council considers that further evidence of benefit without harm of such a system is needed before supporting the proposal for change in Scotland.

"We are of the view that no further legislative change should take place in Scotland until a proper assessment has been made of the impact of the implementation of the Human Transplantation (Wales) Bill.

"Although the implementation of this legislation is not due to begin until December 2015, and it will be some years before the impact of this on the levels of organs and tissues becoming available for donation is able to be fully assessed, we believe this to be the best and most responsible approach."