The British Medical Association is currently proposing a change from an opt-in system for organ donation to one requiring an explicit opt-out for those citizens who do not want to donate. This would all be fine if the UK didn't use such a poor definition of death as its present standard of brain stem death. To label a patient as dead, their doctors need to perform just six simple manual bedside tests. These are, 1) shine a light in their eyes, 2) squirt cold water into their ears, 3) poke them gently in the eye, 4) poke more firmly toward the edge of the eye, 5) try to get them to gag or cough, 6) take them off respirator support for five or ten minutes and see if they spontaneously start breathing. This final test is an incredibly dangerous thing to do and risks both further brain damage and even immediate death.

The truth about brain stem death is that it is a diagnosis not of death, but of a dire condition with little chance (and if the diagnosis is accurate, possibly no chance at all) of the patient ever becoming responsive. If you accept this fact, you must conclude that the patient's true transition from life to death occurs on the operating room table as their organs are removed. Of course once a person is labelled "dead", providing them with the care of a qualified anaesthetist for the duration of the organ harvesting is just a ridiculously wasteful expense for a health service under pressure.

Before you join in with the applause for these proposed changes, have a think about how you would feel if a loved one of yours were deprived of oxygen for ten minutes in a procedure that might not even be mentioned to you. Think also of your loved one with a brain stem so injured that their eyes do not blink but with physiological and even motor responses to pain, and who-knows-what awareness and higher functions remaining, being opened up with electric saws at maximum speed.

Organ donation is important and at the present remains a necessity, but the plans to widen it's reach are an opportunity to demand of the doctors in this field that they are honest about what they are doing and that they improve their practices. In order to label someone as dead, brain-stem death and its ridiculously low-tech diagnostic standard should be abandoned. We should join the rest of the developed world in using a standard of whole-brain death, and it should require elaborate and prolonged testing involving advanced technologies such as brain imaging to assess the levels of brain activity under various sensory stimuli over time before the grave step of labelling an apparently live person as dead is taken. For the patients who cannot be proven to be in an irreversible state of whole-brain death, but who are expected to worsen and die even with all possible interventions, let the doctors who would take their organs present a case based on the reality of what they would be doing.
Let them present the case for sacrificing live patients with no hope of recovery for the sake of other patients whose lives can be saved by an organ donation.
That is a legally difficult but morally defensible position. Once harvesting of organs is admitted to involve the living rather than the dead, at the very least it would mandate providing the donors with the same standard of anaesthesia, care, and dignity as the organ recipients. Whatever you think of the above, at least agree with me that we should give all donors the benefit of the doubt and require through legislation that they are anaesthetised and cared for just as though they were still alive.