Interview: Glyn Davies on ‘presumed consent’

By Phoebe Cooke

So you're a long-standing opponent of presumed consent organ donation, can you tell us why?

I'm a long-standing supporter of organ donation; I want to see the number of organs donated increased. But I don't think introducing presumed consent into the system will be in any way beneficial. It certainly won't increase the number of organs, there's no evidence anywhere in the world it will do that. It will also have the danger of introducing complexities into the UK system and it runs a real risk of ruining the success we've been having with organ donation over the last five years.

What are the complexities?

Well if you've got one system on the one side of the border and a different system in Wales, you're going to have people who are moving from one place to the other. I mean, the England and Wales border is not like a normal administrative border, and I just think it'll introduce real complexities. And you'd find the same point of view if health ministers were being more vocal here about the dangers of this. The previous health minister has been public in his response to me. Andrew Lansley certainly takes the same view as I do and I think you'd find that if the health ministers were being public about their view – which they're not – they'd also have serious concerns.

One argument for presumed consent is that most people don't make an effort to get a donor card, even if they would be perfectly happy to consent to organ donation. This way, all the ambivalent people will automatically be donating their organs after they die unless they state specifically otherwise, whereas as it stands only those who have specifically stated so will donate their organs.

Well the donation card system itself is only a way of making people aware that there is an organ donation system. The only way of increasing the number of organs available is to have a system in place and coordinators in hospitals where this is likely to happen. The most successful country in the world for organ donation – Spain – doesn't actually have a donor card system in place.

How does the system work in Spain?

Well everyone's asked there! When anyone's in an intensive care unit and effectively brain dead – and so in the position where they can potentially donate – their next-of-kin are asked. And what we need to do is to have a system.

I suppose the argument against that is that it should be the decision of the person whose organs may be donated, rather than their next-of-kin if possible – and that's a decision that can be made properly when they have full mental capacity.

If you carry your donor card clearly that's an indication to everybody that you want to donate. And I think that's very good. But I think the system that you want is that everybody is asked. Normally, people generally speaking won't donate if they've thought about it before, because it comes as a pretty serious shock to the next of kin when somebody's in that position. Taking an immediate decision is a very difficult thing to do. Quite often the refusal rating's about 40%, which is too high. I think what successful countries will do is to introduce a system whereby there are very  professional coordinators in each location that help the family take these difficult decisions, and a lot of effort goes into having a systemthe general population knows about so that they're not usually shocked when they're asked.

That's what's happened in Britain. In Gordon Brown set up a hugely comprehensive study group called the Organ Donation Taskforce in 2006, and nearly all the members of that were in favour of presumed consent. But they produced a report in 2007 which changed all of their minds.

People in favour of presumed consent have argued that it will increase the number of donations. Surely with presumed consent, the huge number of ambivalent people who don't really mind either way will now be donating, where previously they wouldn't have done?

What evidence do you have for that? It's been done in a lot of countries all over the world, and there's no evidence that organ donation has increased.

Proponents of presumed consent are saying not only will organ donation significantly increase, but rather than complicating logistics between Wales and England, Wales will be paving the way on reform. What do you say to that?

Well I don't agree with that. It's difficult for me to respond to what you're saying because some of the things you're saying reflect what the government in Wales has been saying for quite a long time, and I don't agree with them. I'm desperately keen to increase the number of organs available, and I'd very much like to be agreeing with the Welsh government if I could, but I see no earthly reason why I should. The trouble is, instinctively people feel that it's inevitably going to increase the number of donations – I think you've articulated why that might be instinctive. But the evidence shows the opposite, which is why it isn't going to make a difference.

Why on earth do you think the Department for Health haven't been in favour of the same thing? Well, because they know it won't make a difference. The Welsh government may and probably will go down this route, but I don't think it's the right one. 

And you also think there will be significant logistical complexities of making it work on both sides of the border?

Well there are obvious logistical issues for when people are moving from one side of the border to the other. My family for example are near the border and would probably have an intensive care bed in England, because there's no transplantation hospital near us.

The issue is hugely a pragmatic one – I want to see everyone's next of kin asked and advised in intensive care units. In successful countries where this has been implemented we've seen a 50% rise in success rates. I think it's a pity when you're in the middle of a success story to introduce a change which – and most professionals would agree with me – will not improve the situation.