Presumed consent to be followed for organ transplants

The law governing the medical use of human organs, tissue and cells was amended at the beginning of August. This allows for the organ donation of a suitable deceased person to be used in the treatment of another individual, unless the deceased had opposed the procedure when alive. "No one's organs would be used against their will, if their wishes are known. The change to the law emphasizes taking account of the deceased's wishes when they were alive", says Raija Asola, Ministerial Counsellor for Health Affairs at the MSAH.

Raija Asola believes that it is a good thing that the amendment to the law has prompted people to consider organ donation in their own case. She would like to remind those who are thinking about the issue that a single donor can save several people's lives, and that an organ transplant recipient often lives a long and normal life. Organ transplants can also help reduce health care costs, as someone who has a kidney transplant, for example, no longer requires dialysis.

"It's important to voice your own view, no matter whether you're for or against organ donation. If you do not agree with it, it is worth notifying your family or to keep a written note of your wishes with you", Asola says.

It is still worthwhile for people who agree with organ donation to follow previous practice and carry a signed organ donor card with them. This provides a clear message concerning one's attitude to being a donor. If people are against the idea, they can state it in any kind of written message and keep it somewhere where their family members or health care personnel can easily find it. They can also request that their refusal be mentioned in their patient records.

When the system of electronic patient records eventually comes into full use throughout Finland, it will be possible to enter patients' positions on organ donation in the basic information on their patient records, which can be accessed by all health care units. The intention is that if patients change their position on the matter, they will be able make the necessary change to the electronic archive using the facility for viewing their own records online.

Asola points out that there is no need for people to deliberate over whether or not their own organs are useable. Health care professionals who decide on organ transplants would determine this. Organs and tissue that have been affected by certain diseases, such as cancer or contagious diseases, cannot be used for transplants.

Asola says that the majority of Finnish respondents to survey questionnaires on organ transplants take a positive view of organ donation. But only some have signed an organ donor card. The presumption of consent is therefore a response to this prevailing situation.

The amendment to the Finnish law is designed to make ease the supply of transplant organs. The need for transplants is increasing, because as medical science develops increasingly more human lives can be saved using appropriate transplant organs or tissue.

Some European countries, such as the Netherlands, Belgium, Italy, Austria, Portugal, France and Spain, already use presumed consent concerning organ donation. Between 1-34 transplants are made in European countries per million inhabitants using deceased donors. The most transplants are carried out in countries that use the presumption of consent.

Asola points out, however, that presumed consent is not by itself enough to increase the numbers of transplants. The crucial point is to identify possible donors, and this requires the continual training of health care personnel.

The debate on organ donation in various media has expressed the fear that care for people who are dying will start to be under pressure concerning the supply of useable organs for transplant, or that organs will start to be bought and sold.

Raija Asola says that such fears lack substance. Health care personnel carry out all the necessary treatment procedures to save patients' lives. Patients are always treated, according to their illness or injury, in the best available ways.

Deciding on organ donation is generally considered when someone has died suddenly. The precondition for donation is that the individual is brain dead. Brain death is most commonly caused by trauma to the skull or haemorrhage inside the skull. Because of this only a small number of deceased individuals can be considered for organ donation.

Asola stresses that the law unambiguously prohibits the trade in human organs in Finland. When they are still living, people can mainly donate bone marrow or one of their kidneys. The only "advantage" they get out of it is the donors allowance covering the time for examination, procedure and recovery, and the fact that they do not have to pay the health care client fees incurred by the donation. With the entry into force of the amended law, the daily allowance may be paid to employers, if they pay wages during the period of sick leave.

Merja Moilanen