So much political disgrace could be avoided if we focused on results rather than on intentions. Passing legislation in parliaments last week to introduce presumed consent for organ donation will probably not lead to a disaster, but the law is likely to be a flop and the campaign to introduce it should concern anyone who hopes for evidence in the policy making.
The idea is simple. Hundreds of people die each year due to a lack of organ donor. If the government departs from the current system, to which people have to participate in the organ donors register, in a system in which people have to leave, there will be more organ donors, more organ donations and more salvation.
In this case, the only challenge for politicians is to convince or crush those who have a moral or religious objection to doctors who collect their organs without permission. I respect the opinions of such people, but I do not share them. The idea of a state that silently holds my body makes me feel a little uncomfortable, but people who die unnecessarily because of beliefs that are essentially absurd are worse. Supporters of presumed consent rightly claim that there is no coercion because it is easy to exclude.
If you have no moral objection to presumed consent, the only question is if it works. And there it falls.
When Wales introduced an opt-out system in 2015, Health Secretary Mark Drakeford described it as "a pioneering step to save lives." First Secretary Carwyn Jones described it as "the law in Wales for the best." He was left to Bishop Swansea and Brecon to be the ghost of the feast, warning that "in appreciating consensus, there is always the danger that this gift idea disappears ".
The results are now in a review published by the Government of Wales last year found that the data "show no consistent change in organ donation donations in Wales" and that there has been "no increase in average quarterly donor levels". These findings were reported by the BBC, and the failure of presumed consent in Wales has been widely discussed in medical media. Nevertheless, MEPs have promoted legislation in England with the ridiculous assurance that it will save hundreds or even thousands of lives every year.
The reality is that one life will not be saved if the results seen in Wales are reproduced in England and it is very likely that lives will be lost. How can this happen when so many people have been activated? It is because, like the fear of the Bishop of Swansea and Brecon, the gift has disappeared.
Many believe that the current system requires explicit consent. Is not. If you die without an organ donation card in your pocket, your relatives can give your consent on your behalf. It is wise to put yourself in the register and explain your desires to your family, but it is not necessary. If you have not enrolled, your relatives can give permission. If you I have they do not have a legitimate veto right.
If you do not want your instruments to be given to someone else, you can put your name in a separate register. Very few people are doing it right now – except for Wales. In 2016/17, England was 27,559 people who had explicitly abandoned the system, just 0.05% of the population. In Wales the number was 175,000 or 5,6%. These are people who have come out of the system for good. Their decision can not be overthrown by the next relatives.
The presumed consensus has therefore led to fewer possible organ donors and we should not be surprised that it has not resulted in more organ donation.
Though counter-intuitive at first glance, this effect seems perfectly reasonable once explained. The Welsh government can be forgiven for experimenting with the idea in 2015. It is not inconceivable that it could work. But now that we have the results of an almost perfect natural experiment, it is unacceptable for British MPs and a national newspaper to make great demands on new legislation that saves hundreds of lives. What is the evidence if it is not taken into account for good intentions?
It is by no means impossible that presumed consent in England will lead to fewer organs being billed, but even if Welsh experience is assimilated and simply has no impact, politics is not free. An important minority will be very dissatisfied with the law being introduced and a lot of money will have to be spent to inform the public about it.
If we want to increase the number of donors, there are better choices. Given the importance of other relatives in the current system, efforts should focus on carefully sensing the critical question in these most difficult times. As noted by Katherine Wright from the Nuffield Center for Biotechnology, the use of specialized nurses to deal with the situation significantly increases the probability of family consent. This is the supposed consensus that helped Spain achieve such a high donation rate.
More controversially, we could abolish the ban on people who sell their organs while they are alive. Some countries provide some form of financial incentive for living organ donors and this seems to work. Less controversial, we could make organ donor cards more accessible to the public. In the 1980s, I remember that it is a common sight in the shops of the shops. What happened to them?
None of these solutions will give Members the warm feeling of justice that they lived last week but, unlike their supposed consent, they could do something good.