Viewpoint: Should organ donors get free funerals?

Paying the funeral expenses of organ donors is a good idea - but safeguards are needed, argues ethicist Simon Rippon.

The Nuffield Council on Bioethics recommends that the NHS offers funeral expense payments to people who sign the organ donor register, on the condition that they later die in circumstances in which their organs can be donated to others.

This idea is to be warmly welcomed. By providing an additional incentive to people already inclined to sign the organ donor register, it could enable the NHS to provide faster and better treatment, and to save many more of the 1,000 people who die every year in Britain while waiting for an organ. It would also provide symbolic recognition of the priceless gift that organ donors give.

Is there anything ethically questionable about this life-saving proposal?

Well, many people think that organ donation should be a purely altruistic matter, and the Nuffield Council attempts to draw a fine line - recommending policies that may provide extra encouragement to those already inclined to donate for altruistic reasons, while strongly scrutinising proposals for introducing more significant incentives which might persuade people to donate who would not otherwise consider it.

Altruism is undoubtedly a good thing, and its role in motivating organ donations should not be underestimated. But enabling altruism should never trump saving lives.

What we should be concerned about when it comes to incentives for organ donation is not the purity of donors' motives, but the way that payments could facilitate coercion or exploitation of those in poverty.

Organ donation should be a fully free choice for each of us, and never an economically necessary one.

For this reason, it is important that organ donation never becomes the only way to pay for one's funeral. The government currently provides funeral payments from the Social Fund to those in poverty. It must continue to do so as a safeguard against coercion and exploitation, if funeral expenses for donors are introduced.

The Nuffield Council's report also considers moving to an "opt-out" system for deceased organ donation, under which it would be assumed that people consent to donation unless they either opt out before they die, or their family later objects.

The council rightly does not oppose such a system on ethical grounds, because it would leave the choice of donation or non-donation entirely in the hands of individuals and their families, as it is now.

Some people object to an opt-out system on the basis that there will inevitably be a few people who fail to opt out and fail to inform their family of their wishes, even though they would not wish their organs to be used to help others - and these people may have their organs taken without consent.

But there's a straightforward reply, arising from the observation that the vast majority of the public support organ donation, though few get around to signing the donor register.

Under the current, opt-in system, there are many more people who fail to sign the donor register and fail to inform their family of their wishes, even though they would wish to help others with the gift of their organs, and these people's organs may go pointlessly to waste without their consent.

If we wish to fulfil the wishes of the most deceased people, then, the default for those who do not express their wishes should be for them to be available to donate.

Nevertheless, the Nuffield Council raises concerns about the practical effects of a change to opt-out - worrying that it might not substantially increase donation rates, and might even reduce the number of donors by prompting vocal opposition.

My view is that the British public is a bit more sensible than the council gives credit for here, and that an opt-out system would produce substantially more donor organs from among those who mean to sign the donor register "when they get around to it".

Nevertheless, the Welsh Assembly looks set to change the system in Wales to opt-out, and the report notes that this provides a rich opportunity for robust research into the likely effects it would have across Britain. If it's not yet ready to act on opt-out, the government should make this research an urgent priority.

Simon Rippon is a Research Fellow at the University of Oxford's Uehiro Centre for Practical Ethics. He writes regularly on ethical issues at the centre's blog: Practical Ethics