Wales will become the first nation in the UK to introduce a policy of presumed consent for organ donation after AMs voted in favour of historic legislation to bring in changes to the system.
The Human Transplantation (Wales) Bill was approved by the National Assembly, with 43 AMs in favour and eight against, following a lengthy and passionate debate on controversial changes to move to an “opt out” system.
Under the Bill, people over the age of 18 who have been a resident in Wales for more than 12 months will have to put in place a clear indication of their wish not to donate their organs for them to be excluded from donation after death, otherwise their consent will be deemed to have been given.
Last night campaigners celebrated the decision after years of lobbying for the change and said the measure would help to save lives. Currently 226 people in Wales are on the transplant waiting list and three people a month die while waiting for an organ.
The British Medical Association’s Welsh Secretary, Dr Richard Lewis, said: “I believe that this is the most important piece of legislation created in Wales since the laws of Hywel Dda.
“A few years ago, Wales was ready to lead the UK on banning smoking in public places, but we didn’t have the necessary legal powers.
“This time we are delighted that our National Assembly has shown the rest of the UK the way forward and fully support its implementation. We congratulate AMs for their enlightenment. Patients across the country will now benefit directly or indirectly benefit from this Bill.
“BMA Cymru Wales and other organisations have been campaigning tirelessly for many years to persuade politicians in Cardiff Bay that this is the right decision and address concerns about how it works. This is the culmination of years of hard work.
“We must all now work hard to ensure that the system works and that everybody understands it.”
Roy J Thomas, chief executive of Kidney Wales Foundation, said: “Deemed consent has a positive and sizeable effect on organ donation rates. Wales has been at the forefront of organ donation with development of the Organ Donor Register in the 1980s to having the DVLA communicate on the issue when sending out driving licenses.
“This law is further progress and evidence shows it will increase donation rates. The new deemed consent system in Wales needs to be given stewardship and trusted to the medical profession.
“In opting for this law Assembly Members are opting for life.”
The “opt out” system, which the Welsh Government believes will result in a 25% increase in the number of available organs in Wales, will come into place in 2015.
Following the vote, the Bill will go to Royal Assent and £4m will be spent communicating the changes to the public.
The Bill is the biggest – and one of the most controversial – pieces of legislation to be made since devolution with faith groups opposing the idea of presumed consent.
People can continue to opt in, opt out or choose not to act and have their consent deemed.
‘Novel’ forms of transplant, such as face and limb transplants, will always require express consent, and people can also opt out of donating certain organs, as is the current process.
One of the legislation’s fiercest critics, the Archbishop of Wales Dr Barry Morgan, has previously said he believes it undermines the idea of organ donation being a ‘gift’.
Prior to the debate a joint statement by faith groups had urged AMs to vote in favour of amendments to give further power to family members.
Health Minister Mark Drakeford had made previous amendments to give the family a “clear right of objection” if they could prove they were aware of the wishes of the deceased.
But during the debate, Shadow Health Minister Darren Millar, who voted against the Bill, echoed calls by faith groups for the legislation to give families the option to decide, rather than convey whether they knew the wishes of deceased.
He said: “I am very supportive of organ donation. The importance of the gift of organ donation cannot be underestimated and should be promoted. For the loved ones of someone who had died, donation can make a positive contribution to the grieving process.
“I’m opposed in principle to a system where organ transplantation becomes a passive act, and consent for it is presumed, or as the Bill puts it deemed, by the state. We need to ensure and inspire public confidence in whatever system we have.
“Family members should have the right to object from their own views.”
However, Prof Drakeford rejected the calls and said a “good deal of mischief” had been made over the role of the family. He said accepting Mr Millar’s proposals, the Bill would “not be what we want it to be.”
He said the Bill was a “historic day” for Wales and showed that Wales was a “progressive nation”.
“This is a Bill that offers hope and hope to people who have no other. People whose very lives depend on transplantation,” he said.
Speaking after the vote, he said: “I am proud that Wales will be the first nation in the UK to take this step. As a society, we have shown we are prepared to take action to increase organ donation and to provide hope to those people waiting every week for a transplant.
“Family refusal is a major factor that affects the numbers of organ donations and the main reason for refusal is lack of knowledge of their loved one’s wishes.
“The family of the potential donor has a major role to play in organ donation. The aim of the Bill has always been to respect the wishes of the deceased, however, relatives or friends of long standing may object to consent being deemed based on what they know about the views of the deceased.
“The new law will work by clarifying people’s wishes around the issue of organ donation and, in turn, increase the rate of consent to donation.
“Today is a landmark day for Wales, and I expect the rest of the UK to be watching with great interest when the legislation is implemented in 2015.”
Mr Millar said: “This has been a landmark day for Wales and – while I hope this achieves the increase in organ donation we all want to see – there is still much work to do.
“The coming months and years must now be spent intensively educating families and communities the length and breadth of Wales.
“This is a significant change from the previous system that remains controversial – and no stone must be left unturned in getting the message across.
“Welsh Conservative amendments focusing on children and the vulnerable, nominated representatives, capacity in critical care, and the rights of the family were all extremely important.
“I remain concerned that not all of our concerns were properly addressed in the legislation and look to the guidance on transplantation to address these issues. We look forward to scrutinising the implementation in due course.”
Leader of the Welsh Liberal Democrats Kirsty Williams supported the Bill and said it was vital that people discussed their position on organ donation with their family.
She said: “The fact is that lives will be saved if this Bill is passed. Significantly, it will also ensure that the issue is given more prominence and that people across Wales will be talking about organ donation. Three people die every month waiting for a transplant. That is three too many.
“We have been told that this legislation will not be enough to increase donor rates, therefore the publicity campaign is important so we carry on urging others to have these conversations.
“Talking about these things does not come easily. It almost seems the very suggestion might in some way make it more likely to happen to you or one of your loved ones, but those discussions must happen. It’s only by having those discussions and having this publicity about what donation can do that will drive up donation rates.”
Plaid Cymru’s health spokeswoman, Elin Jones, said:“The Bill is an important piece of legislation which is sure to save lives in Wales.
“However the Welsh Government must not be complacent on this issue. These changes to the law need to be supported with a concerted effort to raise awareness of this matter organ donation, to ensure that the people of Wales are aware of the impact of the choices they make on this matter.”
Members of the medical profession said they would do all they can to help make the Bill a success for Wales.
Professor John Saunders, chair of the ethics committee of the Royal College of Physicians (RCP), said: “The RCP welcomes effective moves to increase organ donation.
“My colleagues and I will do all we can to help make sure it is a success. This will mean changes to the way we think about organ donation and the way we organise our transplantation services.
“Wales is leading the way with this Bill, and we will be seen as the test case for other countries. If this Bill is to make a real difference to people’s lives, we must do all we can do to ensure that we measure the benefits properly.”