Does it matter if organ donor opt out doesn't work?

By Brian Clegg

I saw an article this weekend bemoaning Westminster’s decision to make organ donation opt-out rather than opt-in in England. Tim Worstall, writing on the Adam Smith Institute’s blog, suggested that it was madness to take this step. And at first glance, his argument was quite strong.

Many government decisions are, frankly, guesswork. There is no good data to back up whether a change will be beneficial or not. But in this case there was some interesting data to consider. Because Wales made this decision earlier, and we now have two years of data on the outcome. According to the BMJ, ‘Welsh opt-out law fails to increase organ donations.’ There has been no significant increase in donation as a result of the change from opt-in to opt-out.

When you think about it (and I suspect few have), this is not totally surprising – because it’s relatively rare that a death will result in organs being available and suitable for transplant. It pretty much requires the donor to be relatively young and healthy, which typically implies being in accident, as a result of which they die in hospital, so the organs can be harvested quickly.

However, I think in terms of social benefit, the opt-out system may well be worthwhile even if it doesn’t do a lot to increase the number of donated organs. It says that we, as a society, care for each other. Politically, I’m a little to the right of centre, but I certainly don’t subscribe to the kind of Ayn Rand view of ‘All I care about is direct benefit for me’. There is little doubt that social attitudes can be changed by this kind of measure.

Is this ‘doing the same thing over and over and expecting different results’ as the blog post suggests? Apparently Einstein said insanity was indicated when this happened – but there’s a lot of difference between a controlled physics experiment (and Einstein, of course was no experimentalist) and a large scale social experiment. Especially when we’re trying to compare an outcome for a country with a population of 3 million with one of 55 million. I doubt if the Adam Smith Institute would consider the economy of Wales a good model for that of England, and it’s equally not an ideal model in this case. Over those two years, we are only talking order of 100 cases in Wales, so this is a very small sample on which to draw any conclusions. We really need significantly more data to be able to draw useful conclusions.

Overall, then, I think rather than decrying it, we probably should see this as a worthwhile step.

Now Appearing is the blog of science writer Brian Clegg (www.brianclegg.net), author of Inflight Science, Before the Big Bang and The God Effect.