UK donor cards and the Organ
Donor Register
274. UK citizens can register their willingness
to donate an organ after their death by joining the Organ Donation
Register (ODR), by carrying a donor card or by making any other
form of advance statement that would be recognised under the terms
of the Mental Capacity Act 2005. Mr Chris Rudge, Managing
Director of UK Transplant, reported that there is "seemingly,
a very high degree of public support for donation—90% of
the population we are told support the principle—but in
practice only 25% of the population are on the Organ Donor Register"
(Q 101). He expressed his regret that there was only a limited
budget available to UK Transplant for promoting the register (Q 107).
275. Views on the effectiveness and significance
of carrying a donor card or registering with the ODR differed.
Patient Concern thought they were little known to the general
public. They cited the Bishop of Southwark who "speaking
on Thought for the Day on BBC Radio 4 related his difficulties
in replacing a lost donor card, when he was told by various agencies
that they 'hadn't seen one for years'". Patient Concern added,
"That is our experience too" (pp 63-66).
276. However, Dr Paul Murphy, an experienced
intensive care doctor who dealt regularly with the families of
donors, felt that the donor card was an important and direct means
for the family and clinician to share an understanding of a potential
donor's consent. He thought, moreover, that "serious consideration
should be given to extending the electronic opportunities to register,
particularly given the increasing access of the population to
on-line services such as Amazon, eBay, YouTube etc." (pp 111-113).
277. There was further support among patient
groups for working to enhance the donor card system. The Patient
Liaison Group of the Royal College of Surgeons, for example, said
that "Information held must be accurate and easily accessed—time
is of the essence. The national register seems a good idea for
the public and clinicians when in urgent need of a donor"
(pp 48-52).
278. The Royal College of Physicians was keen
that other options than the use of a donor card should be explored.
They took the view that "The success in increasing donor
card registrations from the Boots Advantage Card scheme[42]
suggested that similar approaches through banks or other commercial
bodies might also be considered." (pp 239-242).
279. Dr Tracy Long, Southampton University,
took the view that there was something to be learnt from how other
EU Member States managed donor registration. She explained that,
in the Netherlands, where they have 40% of the population on the
donor register, the register provided for three options: agreement
to donate organs; disagreement; or decision to be left to a relative.
She said that it was thought that the possibility of choosing
from these three options encouraged individuals to register, because
they knew that their wishes would be clear (Q 206).
The role of the family
280. Under the 2004 Act, "appropriate consent"
to donate organs is considered to have come from a deceased person
if the person had given explicit consent, by registering as an
organ donor or by carrying a signed donor card. If no prior consent
had been given, the consent of a representative nominated before
death by the deceased person is acceptable. If no such nomination
had been made, people who had a "qualifying relationship"
with the deceased would be eligible under the Act to consent on
behalf of the deceased.[43]
281. The HTA Code of Practice relating to consent
under the Act ranks such eligible relatives in order of the closeness
of their relationship for the purpose of authorising donation
ranging from a spouse or partner (including civil or same sex
partner); parent or child; brother or sister and other relatives
to a friend of long standing (see Box 3). This enables specialist
healthcare professionals seeking permission for donation
to know whom they should approach and in what order.
BOX 3
Qualifying relationships for giving consent to organ donation
