Sir, – The letter "Organ donation and a system of consent" (January 28th), on behalf of the Irish Kidney Association, refers to a report which I wrote in 2005 in relation to postmortem and organ retention practices in Ireland.
My findings in relation to the issue of consent were that consent is not required to be given where a postmortem examination is authorised by a coroner within the terms of his legal powers under the Coroners Act 1962.
My report did not recommend any change to that position as it is necessary in the public interest that coroners are so authorised.
In relation to non-coronial or hospital postmortems at which it may be necessary and appropriate for the pathologist to retain organs in order to carry out a thorough investigation of the cause(s) of death, my recommendations were that parents of deceased children should be given as much information relating to the process as they wish to have, and should then be invited to authorise a postmortem examination on their child to proceed.
Postmortem practice and organ transplantation are two different clinical practices with different aims and objectives which ought not to be confused.
The first is a very important practice which provides crucial information to families about the cause of death of their loved one, and also provides valuable information to clinicians and researchers from which society can benefit in the future through the development of new diagnostic tools, surgical techniques and medicines.
Organ transplantation is a vitally important and necessary clinical practice which can save lives and improve the health and wellbeing of patients.
I would like to clarify that my report did not refer to the issue of presumed consent either for postmortem examination or organ transplantation.
In my opinion, the difficulties that arose in the past in relation to postmortem practice were as a result of a failure to clearly inform families about what would happen at a postmortem examination and a failure to respect their need to be involved in decision-making, as well as a general lack of public awareness of the practice and importance of postmortem examinations.
By comparison, systems of presumed consent for organ donation are generally introduced by means of legislation following full public consultation, and are predicated on education and societal awareness of the circumstances in which presumed consent may operate and the mechanism by which people are entirely free to opt out of the use of their organs in those circumstances.
So-called “soft presumed consent” models still seek the involvement of families before organs are removed for transplantation.
If there is any link between authorisation of postmortems and presumed consent for organ donation, it is that the success of both depends upon greater public awareness and education on what both of these clinical practices involve and the individual and societal benefits that can be achieved from them, as well as the sensitive provision of comprehensible information and bereavement support for families in these difficult circumstances. – Yours, etc,
Prof DEIRDRE
MADDEN,
School of Law,
University College
Cork.