It seems as though the issue of presumed consent blew up quite loudly in the end which is good to see, it needs to be debated and it is quite literally everywhere except the headline news right now. But in the debate there have been some things come up which are worth some clarification or further discussion, in some cases because they're not necessarily true, and in others because they're being used as arguments against change without any real thought going into such arguments. I'm going to tackle the following issues that have been raised from both sides

• "Doctors will feel the need to let us die quicker for our organs"
• "This is state ownership of my body"
• "There will be huge screw ups and scandals because of opt-out"
• "What about sudden deaths?"
• "This is an anti-religious policy"
• "I'll opt out in protest despite being a donor"
• "Who cares, when you're dead you're dead"
• "Surely a free market on organs is the way forward?"
• "Why don't we try asking first?"

Doctors malpractice

Let's get this cleared up right away, a scaremongering excuse for not changing which is actually in all likelihood more counter productive to ones stance than losing the argument. The assertion here is that doctors, in what everyone can acknowledge is a targets driven culture, will be driven to declare patients dead sooner than they would "normally" so that they can use the organs to save more lives quicker. Fortunately this falls down in a few areas.

Firstly doctors that deal with the life and death of a patient are separate from those that deal with organ donation and the process of moving organs on to those that are next in the waiting list. There is little in the way of conflict of interest here as the "targets" being talked about are most likely separate from each other. Secondly, there is anecdotal evidence to suggest that doctors and hospitals would prefer to retain more organs and have done so against protocol, but no evidence this was done to the detriment of the care of the children involved. Thirdly, the above example happened because of poor donor rates and is the main crux of why this scare story is so false. It is now that is the time that doctors and health services are likely to act inappropriately if at all because 7000+ people are left on the waiting lists for organs year after year. With a new presumed consent system it potentially (though it is unlikely) could push than number down to around 3000-4000 per year, 50% of waiting lists as opposed to just 12%. This ease of pressure on "targets" would mean better healthcare for everyone in the system because of reduced stress over current targets and because the issue of having enough organs would no longer be present.

State owns my soul

Another argument is more of a personal political one, that this is tantamount to the state trying to take ownership of ones body. This is quite simple to rebuff, it's called "presumed consent" for a reason. Perhaps there is a need here for a wider scale research into public opinion but this policy is based on years of polls that state the public are very much in favour of organ donation, and as such the government wishes to take that majority as such and stop making them the ones doing all the work to do what they think is best. I'd agree completely with those arguing about the state if the ability to opt-out wasn't present, but the fact you have a free choice to state your preference means that you are still in complete ownership of your body and what is done with it when you die.

Clerical error!

The above concern leads on to the second, and it would be disrespectful under the current climate to rubbish any claim that the state can just "get it wrong". The idea that we can all opt out or not to our heart's content but what about those handful of times when someone that wished to be kept intact in death ends up becoming a donor. It's a tragic thought and perhaps naive to say that it will never happen. I have to ask, however, whether it is more likely that this would happen now compared to when there are more organs out there being donated because of a presumed consent system. On one hand doctors would be more inclined through procedure to take organs because it is likely most people would not have opted out, but on the other there would be less desire by the doctors than currently to try and get organs they need.

The fact is that anything that could go wrong under presumed consent could go wrong now, and the real task is in making sure everyone who wants to opt out can do so easily. Making the opt out as simple as a tick in a box when you apply for a driving license, a passport, a student loan, when you renew your electoral details, etc. The more it is advertised and made clear to people from a young age, with a huge push in advertising in the beginning, the less likely it is for anyone to be "harvested" wrongly.

Crash course

What this raises questions over, however, is sudden death...especially in the young. Some have said the fact that kids and young adults could die before they have the chance to opt out is proof that we shouldn't use the system. I think that is very limited and negative thinking. A range of solutions starting from engaging with our children about death and the realities of protecting one's self and loved ones, encouraging the writing of wills from a younger age, and indeed a multi-layered policy that allows parents and guardians of people below a certain age to dictate what happens with organs in all cases (called the "soft" approach in Spain) can go a long way, possibly all the way, to irradiating the "wrong choice" being made by the doctors involved.

What shall I take to heaven?

The solutions that could be discussed around sudden death of the young are also ones that can be adapted to protect religion. Now while religions aren't as prohibitive of organ donation as you might think, it is clear that certain religions may see more wishing to not donate their organs. They shouldn't be criticised for this, my personal belief is that in not doing so you are starving another person of the chance of life but religion is a hugely complex matter over which none of us can claim to be right on these kinds of issues. How hard would it be to allow the "soft" approach for members of religions known to be tentative about organ donation, something possible even on top of additional advertisement of the options to religious groups. All in all I find it hard to believe the driven and die hard groups in our society that are against organ donation will be the ones that lose out in the task of opting out.

Throwing the toys out of the pram

One of the more disgusting angles to come from this whole debate are those that are so personally aggrieved on a political ideology level that they state they would opt-out and stop being a donor if this system came in. I really don't know what to respond to these people, but clearly helping people though becoming a donor wasn't the primary reason they took on the card in the first place, otherwise they wouldn't be able to threaten such inhumane bollocks over a policy discussion.

Here today, gone tomorrow

Not everything strange is coming from the mouths of those that look more inwardly, in fact those that are decidedly more existential have said their own fair share of silly things. One of these is that "when you're dead, you're dead...get over it!" While I can certainly understand completely what they are saying (I agree with them mostly) to use such *beliefs* as an argument against people is more stoking the flames the simmering the stew. In this sort of case spirituality and religion would always have a present overbearing force on the debate, and to ignore that power over peoples wishes is to just be ignorant of the need to find the best policy that works for everyone if it is to be succesful. Yes, biologically we are gone when we die, we have no use for our organs...but even more guaranteed than the contract on a house is that you someone can prove a dead you was you before, and with family members around to keep your wishes alive it is extremely false to state you have no say over what you do when you're dead.

Penny a piece, love

Thankfully the above is about as ridiculous as "my side" of the debate has gotten, and in comparison is pretty tame to this. Create a free market on organs was proposed on Liberal Conspiracy by one commentator. The idea is simple, when you die your organs are bought and the money goes to your family, the NHS can buy organs they need or individuals can. You could even buy organs from a person who is near to death so they can spend their last days on a holiday or something.

Quite aside from the economic arguments that show that poor people lose out in such systems (the rich would be able to afford to get organs first, and the poor would be more inclined to sell them despite beliefs they had), requiring the NHS to buy organs would reduce the healthcare of this nation through the added cost, there would be no spare organs for the NHS to sell to make up some capital of their own, and indeed because waiting lists look like they will always be longer than the amount of organs around it is those poor people counting on the NHS for their organs that are even less likely to ever get one. The final nail in the coffin for this ludicrous idea, however, has to be that if you thought rouge doctors letting you die for your organs was bad, wait until you have a family with financial problem in control of your life support under such a scheme!

Say please

Dizzy wonders on his blog the following:

As I have said before, if people were asked whenever they went into hospital if they were willing to be a donor as a simple signing in question then, if polling on organ donation willingness is correct, you would see an increase in available donors. The problem is not that the 'opt-in' doesn't work, it's that no one asks the question until the worst possible time to the distraught next-of-kin. Stop presuming, start asking."

In all honesty I can't find fault with this argument, which is refreshing in a whole see of irrational scare tactics and logical fallacies. If it was part of medical protocol that you were asked when registering with a GP, and perhaps even followed up on every few years to ensure that a change in mind or belief hasn't changed your wishes, then surely the general public should be pretty covered in having their consent heard. So maybe all of this fuss is over nothing and it is really just this refinement of our procedures that we need. All in all the potential errors that people complain about the "presumed consent" system would be the same, the issue with sudden deaths could be the same, and there are added risks that would still need to be managed such as the influence of families...but obviously it would fit in much better politically with those that will irrationally rail against this government for using outside the box thinking to try and save more lives each year.