Organ Donation: Time for an Honest National Debate

It is somewhat ironic given that I write blogs for a think tank that I always approach my own social media channels with total trepidation and scepticism. Here is a fine selection of the opening lines from posts some of my LinkedIn contacts have published in the last 24 hours:

“April always feels more honest than March.”

“Lawyers often struggle with substance abuse and addiction. And I am no different.”

“For many years, I was the capable one.”

“You don’t need to be interesting on social media. You need to be useful.”

“I was telling my daughter the other morning how exhausted I sometimes feel after a run of 1:1 Zoom calls.”

“Twenty one years. One constant. People.”

“Monday rolls around and I don’t feel like I’ve had a weekend”

“As a lawyer, I thought I wanted total freedom.”

“I’ve not been on here much.”

“I was warned not to post my last update here.”

Got the idea? A fine selection of total unadulterated self-indulgent nonsense (although fair play to a lawyer with the bravery to admit he’s on drugs; I wonder if he’ll be posting that he’s recently open to work at some point soon…).

There was, however, one post from a former colleague of mine which was worth reading. She announced that her brother had had his life support turned off in the preceding 24 hours following a freak accident which left him brain dead (he was in his early fifties). His family made the decision for him to become an organ donor. As his sister described “this allowed us and him to pass on the gift of life and ensure that other families aren’t having to suffer the pain that we are currently going through.”

Organ donation is something none of us wants to talk about; no one wants to comprehend their own mortality, nor that of a loved one, but it is fast becoming something that all of us are going to have to think about shortly.

But it is an important conversation for us to have. Recent NHS data indicates that there are up to 8,000 patients in the UK who are currently wating for an organ transplant, a record high. In 2024/25, 4,583 transplants were performed, a 2% decrease from 2023/24. In the same time period, 1,403 people donated organs after death, a decrease of 7% from the previous year.

I think we can agree that we are reaching a crisis point.

To be fair to Theresa May (and that is not something I would usually say), she did attempt to ease the problem when she was prime minister, by introducing the opt-out system. Whilst this now means that a patient in England and Wales now has to “opt out” of donation rather than “opting in,” families of the deceased still have the right to block donations. Estimates suggest that there were 2,040 blocked donations in 2024, usually for cultural or religious beliefs.

Don’t worry, I am not going to start preaching what you should or shouldn’t do; these are intensely personal decisions which only the individual can reach. To be honest, I am not sure how I feel about this; I really hadn’t given it any thought until recently and it reminds me of something my late grandmother once said when she was asked if she had considered her funeral: “I really don’t care what happens to my corpse when I am dead, you can throw it on a bonfire for all I care.”

Whilst you can all rest assured that my grandmother was not cremated in some pagan inspired ceremony, I can see the logic; when I am dead, I am indeed dead. It will make little difference to me if I am buried or cremated with all my organs or not. And if I can pass on live, then perhaps I may finally be some of use.

My one concern has always been with an opt-out system is whether a patient is afforded the same level of care if there is the possibility of organ donation than is given to another patient whose organs cannot be donated. Doctors of my acquaintance assure that the same standard of care is provided, but the cynic in me respects realpolitik too much that I still have my suspicions…

However, what I do think is important is that we have some form of national conversation about organ donation. It is vital that we are all given the opportunity to decide for ourselves what our final wishes should be. You may believe passionately that if you have opportunity to provide a gift, then you will. Likewise, your beliefs may disagree. That is fine, as this is a decision which only the individual can make.

No one likes to think about death, let alone our own final hours. But perhaps the issue is that not enough thought is given until the very end, whereas a more mature conversation will at least provide us with the opportunity for considered decisions to be made.