THE other day I received a form to renew my driving licence. Going through the sections, I was appalled to see one for organ donation. There was a list of organs that I might want to donate, including heart, cornea, pancreas, lungs and liver – and with no opportunity to opt out.
Yet going through the accompanying guidelines – thank goodness – I read that I did not have to fill in this section. So of course I didn’t. But what, I wondered, has organ donation got to do with renewing your driving licence?
This section has apparently been on driving licence applications since 2011 but either I never noticed it before or had forgotten because I would certainly have regarded such an intrusion with a howl of outrage.
I have since learned that if the number 118 appears on the back of your driving licence, you are an organ donor. I checked the back of my existing licence and yes, it does have the number 118 on it. And until now, I never knew and had never even looked at the back of my driving licence. Did I inadvertently put a cross in the organ donor box? If so, I can only hope that, having opted out on the new form, this number will not appear on my renewed licence.
All this is bad enough, but it doesn’t stop there. Organ donation sections have now appeared on passport renewal applications as well. Once more, what has applying for a passport got to do with donating your organs? True, you can opt out as with driving licence renewal, but it is made clear that you are expected to opt in. How many more official forms of the future will also start to include a section on organ donation?
The NHS is doing everything it can to persuade people to donate their organs after their death, but in fact you are not actually dead when these organs are harvested from your body. You are, rather, ‘brain dead’. This term was invented in 1967, when the first human heart transplant was carried out by Dr Christiaan Barnard. This term has since been replaced by ‘brain-stem death’, but it means pretty much the same thing.
‘Brain dead’ was a concept invented so that organs can be taken from the body while it is still on life support. Vital organs such as heart, liver and lungs have to be removed while the patient is technically alive, otherwise they deteriorate quickly and become unusable.
In many cases the brain dead patient would die soon anyway, but that is not the point. The organs have to be taken from somebody who has not quite died. You cannot transplant organs from a cold corpse, or cadaver.
And things are getting worse. The NHS strategy ‘Organ Donation and Transplantation 2030’ aims to make this a routine part of health care, with as many people as possible donating their organs, both when fully alive and when ‘brain dead’.
But try as they might, the NHS cannot force you to become an organ donor. As well as ignoring the organ donation section on my new driving licence application, I have opted out on the NHS form, even though they make it difficult for you to do so. The implication is that you are being horribly selfish not to sign up for organ donation as you might give somebody else the precious gift of life. But what, I might ask, about my precious gift of life?
When my time comes, I hope that my wishes will be honoured and that the ghouls will not ransack my not-quite-dead body for all the organs they can use, or put me on life support so that they can do so. It’s possible that by then my organs may be so ancient they are not much use to anybody anyway, but even so, it’s an uncomfortable thought.
In 2024, The Story of a Heart by Rachel Clarke, about a heart transplant, was published. (Clarke is the author of Breathtaking (2021) about working in the NHS during covid, which was turned into a TV series of the same name.) The Story of a Heart became an instant bestseller and received many rave reviews as well as winning major prizes. Among the glowing reviews and mentions, there was not one dissenting voice. Not one reviewer asked what ‘brain dead’ might actually mean, although it was mentioned in the book.
The heartrending tale here – Clarke is particularly good at heartrending – tells the story of Keira, a nine-year-old girl who suffered terrible injuries in a car crash in 2017. After her parents were told that she was brain dead – note that phrase – they gave consent for her heart to be donated to a nine-year-old boy, Max, who was dangerously ill in hospital with an enlarged heart. The donation was made and Max, made a miraculous recovery. Now 17, he is raising awareness, as the phrase goes, for more families to consent to organ donation.
This case gave rise to the Organ Donation (Deemed Consent) Act of 2019, which states that unless somebody specifically opts out, they are ‘deemed’ to have given consent to have their organs removed and transplanted into others. How long, I wonder, before the choice to opt out is removed?
Organ transplantation has been hailed as a miracle of modern medical science and in some ways it is, but organ donation is actually a multi-billion-pound worldwide industry more than the heroic altruistic procedure it is often made out to be.
And even once the organ is successfully transplanted – which does not always happen by any means – life is not plain sailing thereafter. Recipients must remain on immunosuppressive drugs for the rest of their lives as there is a serious risk of the alien organ being rejected. This means they are at greatly increased risk of succumbing to infections, and will need more drugs to combat this vulnerability. The survival rate for heart transplant patients is currently ten to 14 years.
Around 30million people in the UK have now signed up to organ donation. But in the immortal words of film producer Samuel Goldwyn, include me out. And at the very least, organ donation sections should be removed from driving licence, passport and other official applications, where they never belonged in the first place. To all TCW readers I would say: look at the back of your driving licence to see whether the dread number 118 appears.
