Battle to end the donor shortage

Spanish success is widely credited to a system of presumed consent under which doctors no longer need explicit permission to remove organs from dead patients to save the lives of others.

Scotland's Health Secretary Nicola Sturgeon and Prime Minister Gordon Brown have both signalled their support for introducing a similar system here where people would have to opt out if they didn't want their organs to be used.

Without it, the UK currently has one of the lowest organ donation rates in Europe, with just 13 donors per million population.

In Scotland, despite the fact more people have joined the organ register than in any other part of the UK, donation levels are even worse, with only nine or 10 donors for every million people.

As a result, some 8000 people in the UK are waiting for an organ transplant, including around 800 in Scotland. And, as the ageing population sees more and more people living longer, demand for transplants is growing at a rate of about 8% annually.

Although increasingly popular, presumed consent remains controversial with patient groups opposing the idea amid fears it could lead to body parts being harvested against people's wishes.

Yesterday it was put to one side as the UK Organ Donation Taskforce put forward a series of separate recommendations for boosting donor numbers.

These include creating a UK-wide network of organ retrieval teams and expanding the role of donor transplant co-ordinators. They also include setting up staff training in an attempt to encourage all NHS staff to view organ donation as the norm rather than something unusual.

The taskforce, which is preparing a new report focusing on presumed consent, estimates that yesterday's proposals would bring about a 50% rise in donors within five years - saving at least 1000 lives UK-wide annually as well as millions in NHS cash.

With the report's authors stressing that improvements should be noticeable in a year to 18 months, Ms Sturgeon announced immediately that all 14 recommendations would be implemented in Scotland as soon as possible.

Speaking to organ donation staff and transplant patients at Edinburgh Royal Infirmary yesterday, she spelled out Scotland's unusual position.

She said: "Possibly as a result of much of the publicity around the importance of organ donation and transplants, more people proportionately are on the organ donor register in Scotland than elsewhere in the UK, and that's a good thing.

"But, conversely, rates of organ donation are lower than they are in the rest of the UK. These statistics mean that we have a particular need to take the kind of action that is recommended in the taskforce report."

John Forsythe, leading Scottish transplant surgeon and chairman of the Scottish Transplant Group, will be tasked with overseeing implementation of the proposals.

He believes the proposals are desperately needed and will make a real impact on the deadly gap between the number of people willing to grant permission for their organs to be used and the numbers dying as they wait for a transplant.

Explaining the urgent need for action, he said: "It's desperate. Around 250 transplants are done each year but to put that in context with the ageing population every year probably around 270 or 280 patients are added to the list. So all the time the waiting list is increasing year on year. About 100 patients per year in Scotland are either removed from the list because they deteriorate to the point that a transplant would no longer benefit them, or die waiting."

On presumed consent, he pointed to statistics showing that while 90% of people say they support organ donation, when tragedy strikes only 35% to 40% actually grant permission.

In Spain, he said, refusal rates were roughly half that, at around 15% to 20%.

He added: "I also see today as a day when we start to see a change in the organ donation system across the UK and Scotland where it will be modernised as it has been in Europe I think it is very important we start on that road and the recommendations, all of them put together, will all make that difference."

Ms Sturgeon repeated that although her personal view was that presumed consent was a good idea, such a system would only be introduced in Scotland "on the basis of sound evidence" and following a full public debate.

Several respected bodies, including the British Medical Association and the Royal College of Surgeons (RCS), have come out in favour of both yesterday's recommendations and the possible introduction of presumed consent.

A spokesman for the RCS said it "broadly supports the move to an opt-out' system for organ donation, provided the public are well provided with information about what the change will mean and vulnerable citizens are given adequate protection".

He added: "The UK continues to experience a shortage in organ donors and many patients cannot be treated as a result. The system adopted in Spain saw a significant increase in the number of donors and we hope that success can be replicated here in the UK".

However, Liberal Democrat shadow health secretary Ross Finnie urged the Scottish Government not to jump the gun on presumed consent.

Professor John Fabre, past-president of the British Transplantation Society, said: "There is simply no evidence that presumed consent works. The link between presumed consent and organ donation rates is extremely tenuous and entirely unproven.

"Spain has a transplant co-ordination network of specially trained doctors and nurses in every hospital likely to have organ donors. That system is the envy of the world, and far superior in scope to the British system.

"It is almost certainly this, rather than presumed consent legislation, that is the main reason for Spain's superior organ donation rates."

Back at Edinburgh Royal Infirmary, Mr Forsythe stressed that organ donation offered a unique chance to turn something tragic into something good.

As he began work on turning yesterday's pledges into reality, he and many others were hoping that the latest proposals really will save lives, and soon.

It changed my life anything leading to more people signing up is good'

FEW families have as much first-hand experience of organ donation as Kathleen Blenman's. Her mother, sister and brother had all had transplants before she, too, underwent the same procedure in 2006.

They suffer from a hereditary condition called polycystic kidney disease which eventually left each of them needing new organs.

After decades of ill health and disruptive dialysis, the operation may have come too late for Kathleen's mother, Eleanor Seago, who died aged just 50 within weeks of her transplant in 1985.

So, nearly 20 years on, when donors were found for Kathleen's brother, Brian Seago, now 52, and then her sister, Patricia, now 46, Kathleen's initial response was relief that it was them and not her.

Although Patricia's transplant also failed, and she is now back on dialysis, Brian's was a success, giving Kathleen some hope when it became clear that she too needed a donor.

Now, two years later, the 49-year-old secretary and cashier from Kelty, near Dunfermline, says her transplant has revolutionised her life.

Kathleen welcomes moves announced yesterday to encourage more people to sign up to the organ register to help save more lives - including Patricia's, and possibly her own two daughters, Colleen, 26, and Kerry-Anne, 29, who may also need new kidneys one day.

She said: "It completely changed my life. Before my transplant I had dialysis for eight years, going to hospital three days a week which had a big impact on me and my family.

"It really affects your quality of life, although I was one of the lucky ones because I was well prepared after living with it in the family all my life.

"I don't think people realise how important it is to join the register. Anything that leads to more people signing up is a good thing."