Nathan Emmerich

Following an Independent Report from the Organ Donation Taskforce in 2008 the possibility of an opt-out Organ Donor Register (ODR) for the UK as a whole become remote. However the vagaries of devolution have allowed the Welsh government to resurrected the idea, if only for the population of Wales. As a general proposition I am against such a system believing it to be a step to far in allowing the state or ‘public’ interests to dominate the individual. However in the case of the current proposals being considered in Wales there are, I think, further concerns that means caution would be recommended. They can be divided into two distinct areas. The first are what we might call practical concerns of implementation and good governance. The second are concerns that suggest that, given the way posthumous organ donation is currently practiced, an opt-out ODR can no longer be considered symmetrical to an opt-in ODR. This indicates a pressing need to reform the current shape of the UK’s ODR.

In the first instance it appears the Welsh proposals will apply to all those who have been resident in Wales for 6 months or more. Presumably this means some official list of Welsh citizens[1] will be used to form the basis of a specifically Welsh ODR and it will be updated every 6 months. Transplant professional will consult the list to ascertain if an individual has opted out. But this relies on them knowing whether an individual is a Welsh citizen. If they cannot find an individual on the list will they be presumed not to be a Welsh citizen? No further corroboration will be available, if they fail to appear on the UK ODR this may be because they simply do not wish to donate or have not, for whatever reason, registered. Only if an individual does appear on the list will healthcare professionals be able to assume an individual is a Welsh citizen and therefore an organ donor. However in this case a Welsh citizen is someone who has been registered as living in Wales for 6 months. Many current Welsh citizens are, I am sure, aware of the proposals, but are they all? And what of those who move to Wales after implementation, will they be made aware of the register and the fact they are automatically included? What of asylum seekers or other socially disenfranchised individuals. How will the Welsh government ensure these people are fully informed of their registration and right to refuse?