The government has just issued a White Paper on proposed laws for organ and tissue donation which asks the public to express a view on whether people should automatically be assumed to be organ donors on their death.

This is known as the ‘opt-out’ system, as individuals would have to state specifically that they do not wish their organs to be used for transplant purposes – or whether they should ‘opt in’ by specifically choosing to be added to the list of those registered to donate their organs.

The White Paper invites public consultation over the next two months.

The current framework for encouraging organ donation in Malta is very limited. There is a small voluntary group, the Transplant Support Group, which clearly does excellent work within the inevitable limits of its resources. It brings together transplantees of organs and tissues both locally and abroad, brings to the attention of the authorities any shortcomings and ethical issues, and promotes an awareness-raising campaign aimed at encouraging more people locally to come forward as organ donors. There is also a Live Donor Transplant Advisory Committee that makes an evaluation of individual cases of organ donation and then recommends the best action to take.

It is clear that more needs to be done if the dearth of organs for transplants (an issue not unique to Malta) is to be improved and properly regulated.

Most countries in Europe and the developed world have proactive Organ Donor Registers under their health service, which encourage organ donation on the death of an individual. Many of these systems are based on the ‘opt out’ system – the assumption that every individual in the country would be willing to donate their organs unless they explicitly opted out before their deaths. This ‘presumed consent’, as it is called, is used in many European countries.

However, this system is also sometimes tempered by a so-called ‘soft’ version when relatives are allowed the last word on organ donation after death. This is the case, for example, in Spain. In Austria, on the other hand, a so-called ‘hard’ version is adopted where the views of relatives after death are not considered.

The White Paper discusses all these various permutations: ‘opt-out’, ‘opt-in’, ‘hard’ and ‘soft’ versions. While it would appear that the Parliamentary Committee on Health Ethics tends to prefer the ‘opt-in’ system already practised here, there are also positive arguments to be made for some sort of ‘presumed consent’ principle to be carefully weighed in the scales, given the undoubted dearth of organs that are available for transplant.

There are also two other aspects which future legislation should consider.

The first is whether the age of consent should be lowered from 18 to allow children as young as 12 to become organ donors, as already happens in Scotland (though it is subject to the parents’ or guardians’ agreement).

The second is the question of purchase of organs. This arose in a recent case of a woman so desperately seeking a transplant for her husband that she was prepared to pay €5,000 to cover the donor’s costs. While it would seem morally repugnant to accept any system that allowed the sale and purchase of human organs for transplantation, the case underlined the need for more organ donors.

The issue of organ donation is ethically sensitive but progress is essential. The need for Malta to improve and regulate the area is most welcome, though the overarching aim should be to ensure that more lives can be saved by making this honourable practice more widespread.

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