The Blog

Chile and Wales Lead Renewed Drive for Opt-Out Organ Donation Scheme

While World Cup qualification is arguably the most prominent thing in most Chilean and Welsh people's minds right now, the two countries have another topic of conversation in common: organ donation.

While World Cup qualification is arguably the most prominent thing in most Chilean and Welsh people's minds right now, the two countries have another topic of conversation in common: organ donation.

Chile and Wales are the two latest countries to vote in favour of introducing the controversial opt-out organ donation system, where individuals are presumed to have given consent for their organs to be donated unless they choose to opt out.

Wales made history in July this year when it became the first country in the UK to adopt the system in a bid to counteract a shortage of organ donors. The new law, which is due to come into force in 2015, aims to increase the number of organs available in Wales by around 25%.

Just the previous month Chilean President Sebastián Piñera signed into law an amendment to convert the country's existing opt-in system - la Ley de Donante Universal, which was first adopted in 2010 - into an opt-out system.

The 2010 law had been heavily criticised and when we look at the latest statistics, we start to see why. Instead of improving the donor situation, the number of registered non-donors in Chile has more than doubled since the law was enacted, according to data recently released by the government. Between January and August 2010, 402 million people registered as non-donors. Yet over the same period in 2013, this number had rocketed to 892 million.

As José Luis Rojas, national transplant coordinator for the country's Department of Health (Minsal), told La Tercera newspaper, one of the main problems under the opt-in system was that few people had the time to consider opting in or failed to realise when they were being asked.

"The mechanism was not good. When people are renewing their identity cards or getting a driving licence, this is just a procedure for them. They are not prepared to answer this type of question. What's more, half of people say that they weren't asked this question or don't even remember being asked."

Today a whopping 3.8 million Chileans are registered as non-donors - so around 22% of the population have (whether knowingly or not) declined to donate their organs. Or to look at it another way: Minsal estimates that there were just 8.8 effective donors per million inhabitants in Chile in 2012, which is a far cry from the world's leading donor Spain, which has a rate of as much as 34 donors per million.

Although it's worth noting that Spain has been very vocal in putting its success in this field more down to the facilities and coordination of the Spanish health service than to its decision to adopt an opt-out scheme.

Nonetheless, the Chilean government is hopeful that things will improve from next month when the new opt-out system is introduced, which will see all Chileans over the age of 18 automatically registered as donors. To de-register, an individual will have to make an appointment with a notary and sign a declaration form.

Opt-out organ donation is not a new thing though and Spain, Belgium, Austria and Sweden are just some of the other countries that have already adopted the scheme. However, not all countries have welcomed the move. Although Brazil adopted a presumed consent law in 1997, it was forced to repeal the law just a year later due to mistrust in the government and accusations of bodysnatching.

Chile's recent troubled past of organ donation dramas will no doubt have played a role in helping to push the most recent legislation through, which perhaps explains why it is being enacted just four months after being signed into law.

In Wales MPs have voted expressly for a "soft opt-out scheme", which means that families will still have a "clear right of objection", according to Welsh health minister Mark Drakeford.

Now let's take a look at the data. According to the most recent figures from NHS Blood and Transplant (NHSBT), in 2012 the donor rate in Wales was 18.3 per million and in the UK as a whole, 16.3 per million.

The number of registered donors in Wales in 2012/13 was 968,751, or 32% of the total population - 1% greater than the national average of 31%, and 2% greater than in both England and Northern Ireland. Scotland leads the pack though, with an impressive 41% of the population currently listed on the organ donor register.

However, concerns over presumed consent have prevented England, Northern Ireland or Scotland from formally considering converting to an opt-out system, although some countries are reported to be mooting the idea.

Chile, with a transplant waiting list of 1,600 in 2012, has already taken the plunge. By the end of June 2013, across the UK there were 7,256 people registered as waiting for transplants. Only 226 of these were in Wales.

While organ donation in the UK has risen by around 50% over the past five years, medical professionals say much more needs to be done and many are in favour of following in Wales and Chile's footsteps.