A OPT-OUT system of organ donation will make "substantial" savings for the NHS on patient care that could be used to fund more transplant surgeons and retrieval teams, say health leaders.

Dr Sue Robertson, a renal specialist and Scottish spokeswoman for the British Medical Association, has dismissed concerns that a presumed consent policy could lead to organs being wasted because the infrastructure would struggle to deal with an influx of donations.

She said the money saved in caring for seriously ill patients requiring transplants, for example on kidney dialysis, could be used to boost the transplant infrastructure.

The Evening Times has launched a campaign urging the Scottish Government to adopt an 'opt out' system of organ donation to address a national shortage of donors on the register.

It would mean that, unless people opted out, or relatives objected, hospitals would be allowed to use their organs for transplants.

Support for a change in the law is backed by major charities, including the British Heart Foundation, Kidney Research UK, Diabetes UK and the Cystic Fibrosis Trust, and the British Medical Association (BMA).

Dr Roberston said: "In Scotland we have increasing numbers of patients waiting for transplants.

"We know 90% of people say they support organ donation, but for lots of reasons only a quarter of the UK population is on the organ donor register.

"If we can improve our organ donation rates, transplantation numbers will increase.

"Looking after people who are waiting for transplants takes a huge amount of health care resource because these people are, by definition, unwell.

"For example, my patients require dialysis, liver patients require a lot of intensive care, and cardiac patients waiting for hearts even more so.

"So you save on looking after the people who are waiting and also you save their distress and illness that comes along with that.

"You replace it with an increase in the need for transplant surgeons and an improvement in infrastructure.

"But you would save an awful lot more than you would spend."

The BMA is supportive of a 'soft' opt out system of presumed consent where relatives would still be consulted, which is already in operation in a number of countries, including Spain.

Research shows it is rare for families to object if they are aware of the wishes of loved ones.

She said: "It allows the doctors to continue their duty of care to the family members by not adding to their distress.

"Moving to an opt out system makes it more likely that the individual's wishes will be known, because to change the system would require a public campaign and people would find out more about transplantation and so we would hope discuss it more.

"It is something that has to be approached very gently and very sensitively, but there is a slightly different spin if people are wanting to give.

"We believe changing to a presumed consent system, along with improvements in the funding of the infrastructure the Scottish Government has already committed to, would increase the numbers of organs available for transplantation.

"We believe countries with a presumed consent system have a higher organ donation rate."

Dr Robertson says much needs to be done to address a general lack of awareness about organ donation procedures.

She says some of the myths and fears, such as doctors turning off life support machines to take organs, must be dispelled.

The doctor, who works in the renal unit at the Dumfries and Galloway Royal Infirmary, said: "People need to be educated that until there is brain death, our only driver as doctors is to do our best for those patients and their families.

"It is only in the event of brain stem death that we would then consider organs for donation.

"We can't keep everyone alive, but we will do our very best for the patient we are looking after until it is futile. Only in that situation, when someone has brain death by testing, would we go ahead.

"I think those are fears we have to work to dispel."

Dr Robertson says an 'opt out' register would be much easier to manage than the current system because it is likely the majority would not 'opt out'.

She believes it would present some challenges for Scotland to go it alone, but is something that should be considered.

Dr Robertson said: "We are part of a UK transplant system, at the moment, so that would throw up a few challenges, but I think it is certainly something that should be discussed and considered.

"Because the register is likely to be much smaller it would be more up to date and easier to manage than the register as it is now.

"We would then have to make sure the system of opting out is quick and easy. It would have to be possible to do it online or by post so no one is excluded in the system.

"I am one of the doctors who looks after the patients waiting for organs and also patients who have had transplants, so I can see what a huge difference it makes to people's lives to get that precious organ and how hard it is for them when they are waiting."

"I have heard from my own patients who have been on dialysis. The morning after they had their transplant, they will say, 'I woke up and I felt cleansed. I felt clean and healthy'.

"It was as if a net curtain had been taken away, everything looked brighter and for them that is fabulous."

caroline.wilson@ eveningtimes.co.uk

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