Changing the law on organ donation to one of presumed consent will mean that we are all organ donors unless we have formally registered an opt-out.Supporters argue that surveys show 80-90% saying that they are willing to donate their organs, while only one in four sign up to the donor register. Therefore, making donation the default position will actually fulfil the wishes of all those who don’t get round to recording them. There are serious question marks here. It may be that many of these people have no intention of donating but simply give a ‘feel good’ answer to a question in the street. A considered decision is a very different matter. The same problems of inertia and forgetfulness that may prevent us the willing from signing up will prevent the unwilling from opting out. The absence of refusal by no means signifies consent.Opting out transforms us from volunteers to conscripts unless we declare ourselves as conscientious objectors, who may well worry that we will suffer discrimination. Enthusiasts extol the example of Spain, with three times as many donated organs as Britain. But ten years after Spain changed the law to presumed consent, the donation rate was the same as ours.

Things only changed when a new head of transplantation changed the system so that Spain has three times the ICU beds and three times the transplant coordinators, as well as three times the donors. No coincidence! Without the necessary infrastructure, we can hardly expect the law to provide a quick fix.
It may instead backfire in a way that will be damaging to the health service. Patients and their relatives may fear that they are more valuable as potential donors than as expensive occupiers of much-needed beds.Organ donation is a gift that should be encouraged and facilitated in every way possible. It is not an obligation and many of us will resent the suggestion that our bodies belong to the state to be plundered for spare parts like used cars.

Joyce Robins is a co-founder of health watchdog Patient Concern