In prosperous countries demand for organ transplants is growing as ageing populations, hypertension, diabetes and obesity take their toll. The gap between donors and recipients of human organs continues to increase. According to Health Parliamentary Secretary Chris Fearne, “this year, 18 kidney transplants were successfully carried out but some 80 patients are waiting for a kidney”.

The renal unit at Mater Dei hospital takes care of 250 patients, with 65 visiting the unit daily. Some of these patients may eventually need a transplant and, unless organ donors increase, the waiting list for organ transplants will increase. If not enough donors are found, one stark consequence could be death.

So the publication of a draft law on organ donation needs to be speeded up to enable the health authorities to come up with a sustainable strategy to bridge the gap between organ donors and recipients.

The politics of organ donation is complex as ethical and cultural issues often complicate what initially may appear as pragmatic solutions to increasing the supply of organs for transplant. The Malta Transplant Support group said it had long been calling on the government to give organ donors the final say about the fate of their organs after they die. The current practice allows next of kin to decide what happens when their relatives pass away – even if that person has registered for organ donation.

Most countries have moved ahead and are considering even more daring solutions to increase the supply of human organs. Most European countries adopt the ‘presumed consent’ approach, where a person is assumed to be a potential donor unless he registers his objection.

However, this solution is not as easy to implement as it may appear. Research in Britain has found that a system of presumed consent for the purpose of organ donation “might damage the vital relationship of trust between dying patients and their doctors”. It also resulted that presumed consent might “remove the emotional benefit to recipients” and their families of knowing that the organs have been freely surrendered – as a gift. Yet the British Medical Association (BMA), which represents doctors, is in favour of the opt-out system.

In countries like Spain, which has a presumed consent law, the number of donors only began to rise significantly after an effective national transplant infrastructure had been set up, backed by publicity to educate the public and explode myths. This took a full decade after the introduction of the opt-out system and Spain today has one of the highest pro-rata donor rates.

But culture and capacity may often matter more than legal regimes that define the politics of organ donation. The medical profession in some countries comes up with even more controversial recommendations to increase the supply of human organs. The BMA “thinks more controversial measures should be debated. These include using organs from higher-risk donors and putting dying patients on a ventilator to retrieve organs later”.

The enactment of a local organ donation law is unlikely to include the more controversial measures being discussed is some countries. Enabling people to determine what happens to their organs after death, rather than leave it to their relatives to decide, should not be a controversial issue.

But what is likely to encourage more people to become organ donors is a sustained public-information campaign combined with an expansion of medical specialists and intensive-care capacity which will convince more people that organ donation can indeed bestow life after death.