Organ donation

If doctors routinely buried cancer drugs or set CT scanners on fire we would gently direct them to the nearest padded cell. Yet when life-saving resources take the form of kidneys, livers, hearts and lungs few bat an eyelid at their needless destruction. Not only that, but modest proposals to stem this waste are met with objections that are as vociferous as they are logic-defying. It is time for this to stop. It is time we adopted a presumed consent system for cadaveric organ donation.

This is what the Welsh Assembly is considering. Unlike the present opt-in system, where the law requires the explicit consent of the donor (or a proxy) in order for deceased organ transplants to be lawful, a presumed consent system would be one where, when the deceased has not registered any objections, consent is presumed. If you don’t want your organs harvested then you have to opt out. Thousands of lives could be saved by such a measure, as we would be able to acquire the organs of not only those who have consented but also those who have not made a decision either way. Indeed, there is evidence that, even taking account of other facts such as education, countries with a presumed consent have a much higher deceased organ procurement rate.

What might be the problem with this if lives are saved? Religious groups have traditionally been troubled by organ donation due to that whole physical resurrection of the body thing they credulously subscribe to. Nowadays they realise that the idea of an all-powerful god who can turn ashes and compost into living, breathing humans, but somehow struggles with working out whose liver is whose, won’t wash with most of the public, so they hamfistedly attempt to dress up their objections in more secular language. Accordingly, church leaders in Wales have said presumed consent “concerns serious human rights issues such as personal autonomy”. Their reasoning is that an opt-out system will give an overweening state too much power and interfere with the liberty of the deceased as the deceased will no longer be able to make decisions about what happens to their bodies.

Leaving aside the fact that this is simply not true – people can decide not to donate organs by opting out – such clumsy thinking demonstrates a colossal misunderstanding of the concept of autonomy. Now, there are many differing views about what it means to be autonomous but what all of them have in common is that an autonomous agent must possess certain capacities. Given that these capacities, such as sentience, are ones that a corpse simply does not have, it makes as much sense to discuss the autonomy of a cadaver as it does the liberty of a lump of granite.

Furthermore, this objection completely ignores the fact that there is no right in law to decide what happens to your body after death anyway. You do not have the option to opt out of post-mortem examinations, for example. If the state did not own the organs, who, exactly, do the objectors think will? It certainly won’t be the deceased person themselves. As the philosopher Janet Radcliffe Richards has pointed out, this objection amounts to a demand to waste organs. Now the anti-presumed-consent brigade is welcome to argue for this if they want to. But, rather than pretending this is a principled stand, they should unambiguously state that they are happy for thousands to die so they can act like the dog in the manger.

People can hold whatever primitive beliefs they like. There is no crime in being superstitious if you do not harm anyone. But preventing presumed consent does just that: it causes harm by leaving thousands in untold misery in order to placate the self-centred and the squeamish. And it does so on the basis of grotesquely flawed reasoning. Bertrand Russell once said that “every moral progress that there has been in the world has been consistently opposed by the organised Churches of the world.” This is no exception. Ignore them and support opt-out.