A debate about organ donation can literally be a debate about life or death. The lives of many were saved thanks to the donation of essential organs (for example a heart) while the quality of life of many more has been greatly enhanced thanks to this generous act.

Organ donation is once more on the national agenda. The Social Affairs Committee of our Parliament is studying the issue and listening to the opinions of experts in the area. The association of medical students of our University has been actively proposing more concrete action including legislation specific on the subject. A white paper will probably be published in the coming months.

The discussion on the subject has highlighted two particular issues: opting out and the ‘authority’ of the organ donor card.

Opting out is the phrase used for a system whereby the state assumes that those who die on the life supporting machines are considered to be organ donors unless they had made a declaration stating that they do not want to be organ donors. In parenthesis I note that with the exception of the cornea only those who die on a life supporting machine can donate organs. This is because these machines keep the organs ‘alive’ through the pumping of blood even after the person had died.

The other subject concern what I described as the ‘authority’ of the donor card. As per current legislation the cadaver belongs to the family who consequently has can decide   not to donate organs even if the deceased had a donor card. This does not mean that a donor card is useless. Experience in Malta and overseas shows that the surviving family members find it much easier to accede to the donation of organs if their loved one was a card carrier. Then find it easier to respect his/her wish.

Two proposals are being mooted. First that a donor card should be considered as the owner’s valid consent to donate organs, a decision that could not be overruled by the family. Secondly that the opting out system becomes law in Malta.

There are valid arguments for and against. I think that a final decision should be taken after an in-depth study of people’s feelings, attitudes and behaviour. Research carried out in Malta a few years back showed that people were ready to donate their organs but they wanted this to be a voluntary act. Back then people resisted the idea that they would be ‘forced’ to donate through an opting-out system. They wanted the state to stay out of this very personal decision.

If this is still the popular will then I believe that the people’s wishes should be respected. Why turn a generous act into a contentions one? I would think otherwise if research shows that people’s expressed wish to donate is not followed with the actual action of donation. If there is dissonance between expressed wish and actual action the opting out system should be introduced.

An important question should be addressed before deciding on whether to change the law as a result of which the family can overrule the wish of the deceased. Are families actually doing this on a regular basis or are such decisions a rare exception? If families respect the wishes of the deceased in almost all cases then I don’t feel that there is need for a change in the legislation. If, however, the contrary is the case then the law should be changed.

I suggest that in the case of organ donation on-going education campaigns could prove more effective than legislation. Such campaigns are, very unfortunately, lacking.

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