Presumed consent or contracting out.

In the United Kingdom, we have become habitu ated to an opting-in system of cadaveric organ procurement. It is becoming of increasing concern that this system is failing to meet the demand for organs for transplantation, with 5,349 people on waiting lists for solid organ transplants at the end of 1998.l Manifestly, such a tragic statistic alarms us all, and calls for urgent attention, and, perhaps, for radical action. And, at one level, this is what we have witnessed in the British Medical Associa tion's (BMA) recent reversal of its historical opposition to a system of so-called presumed con sent for the procurement of cadaver organs.2 3 The BMA's overwhelming vote in favour of changing to an opt-out system at its annual conference in early July followed, almost immediately, publi cation of the results of a government survey which showed a lack of public support for such a system,4 and it thus came as no great surprise that the government later rejected the BMA's proposal.5 6 Bad timing perhaps, but, whilst any necessary change in legislation might be minimal, if the United Kingdom was to adopt a system of cadaveric organ donation based on presumed consent, this would clearly represent a major overhaul of social policy in this area, and an over night tidal change in public opinion is hardly to be expected. For the sake of argument, let us accept the gen eral view that presumed consent legislation does increase the yield of cadaver organs for transplantation.7 8 However, there is more than efficiency to consider, and here we will be concerned with arguments from moral principle, not from statistics.9