The British Medical Association has long enthusiastically supported presumed consent for organ donation, while strongly opposing presumed consent for doctors uploading patient records to a central electronic database. This leads to the suspicion that ethics, to the BMA, are what best suits doctors.

There is an important lesson to be learned from the progress of the electronic records initiative. Enthusiasts for presumed consent insisted that a vigorous public information programme would ensure everyone was aware of the new scheme and the opportunity for opting out. In fact, a survey of the trial areas showed that in spite of an information blitz, most people neither knew nor understood what had happened to their records.

If a presumed consent system for donating organs is as little understood and just one organ is taken when it can be shown that the "donor" was unwilling, the fallout would be enormous and could do irreparable harm to the whole donation programme.

A donation is a gift, willingly given. Otherwise it is a requisition.

Joyce Robins, co-director, Patient Concern

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