Living people matter. When you're dead, you're dead

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Living people matter. When you're dead, you're dead

Polly Toynbee
Tuesday January 15, 2008
The Guardian

Brown's proposal on organ donation could end needless deaths that stem from the misguided instincts of the few

Gordon Brown has made a bold move on organ donation. It will lead to a knock-down, drag-out fight with the forces of superstition and reaction - but the spirit of the enlightenment will win. When you are dead, you are dead. Living people matter, but dead bodies do not.

Urged on by the chief medical officer, Brown proposes that everyone should be presumed to give consent for their organs to be used after death to save the lives of others. Those who object can register their refusal during their lifetime - or their relatives can refuse. Otherwise heart, lungs, liver, kidneys, corneas and any other life-saving spare parts can be used to transform the lives of many others. And not before time.

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Four years ago Tony Blair imposed a three-line whip on a vote to crush a motion put forward by the Liberal Democrat MP Evan Harris on exactly this proposal. Maybe that was a symptom of Blair the novice Catholic. Maybe it was the shadow of the Alder Hey hospital furore, when parents discovered bits of their dead children's bodies had been taken without permission by a rogue pathologist. The grisly spectacle of them solemnly conducting second funerals for pickled missing organs was treated by the press with unctuous respect.

But the mood has changed and Labour has a new leader. When the chief medical officer, Sir Liam Donaldson, made the recommendation for presumed consent in his annual report last July, he immediately got a warm response from Downing Street. Tomorrow a taskforce will recommend more determined efforts to get consent from relatives of dying patients. It's often a low priority for intensive-care doctors who are not the same doctors treating those dying for lack of an organ. This move may help, but it won't solve the organ shortage.

Eight thousand people wait each year for organs, but only 3,000 transplants are carried out. At least a thousand lives could be saved with the release of more viable organs. People die, often in terrible suffering, waiting and hoping for a kidney or a heart - often summoned to hospital for a transplant, only to be disappointed. Some 10,000 other very sick people could be cured or have their sight saved with a transplant.

For years now there has been hope of a major breakthrough by using animal organs. Back in 1996 I served on the Department of Health's committee on xenotransplantation, examining the ethical, safety and practical aspects of using transgenic animal organs for human transplants. At the time pigs' organs seemed to be on the verge of providing the easy answer - only for hopes to be dashed. Ever since transplant surgery became routine, patients have died needlessly because of the squeamishness of politicians not daring to bring in presumed consent.

How many is 1,000 lives a year? Imagine if the government promised there would be no murders next year (755), plus no pedal cycle deaths (146); or no pedestrian deaths (675); or no motorbike deaths (599); or no deaths from falling down stairs (1,000). Imagine if the NHS could promise no deaths from cervical cancer (1,061) or from bone cancer (1,007). In that context, a government saving 1,000 lives a year with a stroke of a pen is an easy win. Then add in the 10,000 other very sick or blind people who will be helped. It is deeply shocking that hundreds of thousands of lives have been blighted or lost over the past decades for no better reason than a few vociferous people's misguided and primitive instincts about the sanctity and integrity of corpses.

Now the first shots are being fired. The Bishop of Southwark has been among the first to oppose Brown's proposal. Astonishingly, Patient Concern and the Patients Association have come out against. (Maybe it should rename itself the Dead Patients Association if it cares more about the dead than the living.) The reason Labour will win is the obvious one: most people are in favour of organ donation, with 90% supporting it - although only 25% get round to putting themselves on the donors' register.

It's an interesting sign of how wrong the Conservatives often get things that their immediate response was to oppose this. The shadow health spokesman, Andrew Lansley, said firmly: "Only four years ago parliament concluded that to take organs without consent was wrong. It is neither right nor necessary for us to change that view." Watch and wait. The chances are that by the time a bill gets to the Commons, the Conservatives will have been forced to change their view.

This is revealing about the way they think. Rightwing commentators are sharpening their pencils for what they see as an excellent ideological dividing line: now the state presumes that it owns the bodies of its citizens! The nanny state has become the bodysnatcher state! Out come the old scares, as told by a maverick retired anaesthetist, that people aren't really dead when organs are taken from brain-dead bodies. This was from the Mail's Melanie Phillips who campaigns against the MMR vaccine on the basis of maverick research evidence. She lays about the BMA and the medical royal colleges for losing the ethical plot on everything from "abortion, embyro research and cloning to starving and dehydrating 'dispensable' patients to death". So here we have an important battle of ideas - and the Conservatives have just instinctively plonked themselves on the wrong side.

If they don't row back to the modernising, commonsense, humane side of this debate, then there could just be reason to start worrying about the direction of British politics. It could be that we might look back and regret that the prime minister himself made the running on a non-party-political issue of the kind usually put forward in a private member's bill. Look across the Atlantic and shudder at how so-called moral issues have supplanted real politics. The phoney politics of religiosity fill the dangerous void when parties strive to abandon their natural right-left fault lines. Absurdly, Tony Blair - speaking to Nicolas Sarkozy's rightwing rally in France last week - proclaimed the end of right and left: in doing so, he proclaims the end of politics itself, in a world devoid of ideas and ideals. Sometimes Gordon Brown, keen not to be cast as tribal, seems eager to mimic this centrist line.

He is right to take up an important issue: it is an outrage that patients suffer and die needlessly. But there is just the hint of a suspicion that he thinks this is clever politics precisely because it's not a left-right controversy.

polly.toynbee@guardian.co.uk

http://www.guardian.co.uk/comment/story/0,,2240864,00.html