Health: The great Welsh organ robbery

Posted by Alexander Hay

The decision by the Welsh assembly to effectively nationalise the bodies of the dead for organ transplant purposes is sinister and authoritarian, not to mention short-sighted and – of course – heavy handed. Meanwhile, medical advances could solve the issue of organ shortages once and for all, but only if it had the funding...

Organ donations are vital for medical treatment, but how far are we willing to go to secure them?Crepuscular, sinister, ruthless and alien, it scurries through the wards at night, seeking its prey. Noting each patient by their health and suitability, it keeps watch, waiting for the first signs of encroaching death, its scalpels, blades and ice box ready...

...Well, that's probably an overstatement. But there is still something quite creepy about plans by the Welsh Assembly to make everyone potential organ donors unless they opt out. For starters, in order not to be considered for the spare parts bucket, you have to actively make clear you don't want to offer up your insides on death. Apart from the potential peer pressure this might lead to ("I heard he doesn't want his organs used after he dies! The selfish swine!!!"), it's also a potential set of disasters waiting to happen.

If you have staff assuming that most corpses are there for the harvesting (as it were), the likelihood of an opted-out corpse getting accidentally asset stripped is considerable. We are, after all, talking about people who would have to work with dead bodies and so need to block a lot of things out to function. (Mortuary workers and pathologists often need to do this to maintain their sanity.) That would not be conducive with always working out who's opted out, whereas an 'opt-in' system has the advantage of finding out who's eligible an active rather than a passive action. Nothing is taken for granted.

The main riposte to this would be that the personal autonomy of a corpse should be secondary to a living person in need of a new heart. The problem with such an argument, however, is that it is based on a fallacy. A corpse can't say 'no', but it can't say 'yes' either, and if you can't respect the dead then how can you respect the living?

This is why the Alder Hey scandal was so shocking and why we no longer display heads on poles or have public hangings - such things have a brutalising effect on society. The 'ends justify the means' mentality behind the Welsh government's decision, meanwhile, hints at a profound cynicism. The public ought to feel uneasy with such politicians in charge.

Secondly, the decision is a massive cop-out for the government and the NHS, who have singularly failed to make a case for people to opt into the donor card scheme. Most people may not want their organs taken from them after death, but there are many people who would be happy for this to happen or wouldn't mind either way, and considerably more than those who have signed up as organ donors.

That they have not been recruited or even approached suggests a profound failure by government to make a case and to treat the public with some respect. Instead it falls back on a sledgehammer approach that makes everyone a potential donor rather than those who would do so if properly asked.

Thirdly, it ignores another possibility - making new organs from scratch. An artificial windpipe has already been successfully used to treat a patient in Sweden. 3D printing will eventually be able to build up new blood vessels and even organs layer by layer, and a device already exists which 'prints' new tissue directly onto severe burns.

Another possibility is growing a patient's cells over a 'scaffold', creating, for example, a new kidney that can be used to replace the damaged organ - patients have already benefited from this too. Even fully mechanical replacements are becoming more viable, as prosthetic limbs for amputees grow more effective and artificial hearts become more reliable.

The main advantage for all these technologies is that they are or would be far more convenient for both the patient and the healthcare provider than relying on organ donors. Even if every body was harvested, that is still no guarantee that a suitable organ could be found.

Also, the patient would then be forced to take immuno-suppressant drugs for the rest of their life, which wouldn't be a problem for many of the new advances mentioned above. What they all have in common is a need for funding, which is something that the NHS and the government would be able to provide if the will was there.

Instead, we have the dismal spectacle of politicians nationalising dead bodies in a desperate attempt to counter their own health policy shortcomings. It is neither effective nor humane, but does have the advantage of making the Welsh government look like it's helping, even though it's not.

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Alexander Hay

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