Last year, only 29 New Zealanders became organ donors after they had died. That is a low number, even for a country in which the annual donation rate over the past decade places it towards the bottom of the developed world. But perhaps it is no more than expected, given the peculiar donation framework. That structure effectively ensures that the final outcome will bear no relation to the fact that 1.1 million people have said "yes" to organ donation on their driver's licence.

The problem starts with the status and scope of that affirmation. Unlike other parts of the licence, it is not legally binding. Nor does it specify what parts of the body can be used for patients needing a transplant. Nor, indeed, is the process of granting approval a matter that drivers are encouraged to regard as more than an afterthought.

All this has meant that people who have signed up to be organ donors do not always have their wishes honoured. In the highly fraught circumstances of emergency rooms, where suitable organs are most likely to become available, doctors allow grief-stricken relatives a veto. They decide, in effect, not to heap more trauma on family members by forcing a donation they do not want.

The sensitivity is understandable. But, notwithstanding the delicacy of the situation, it also denies donors their wish. And that fundamental fact has prompted an increasing demand for a more cogent donation framework, one which ensures donors' wishes are honoured and which alleviates the pressure on doctors to bow to the view of grieving families.

That demand has prompted a public petition, an expanded national donation agency, and a recommendation by Parliament's health select committee that an organ donor register should be linked to the driving licence database. The latter was initially rejected by the Government. But it has subsequently promised to set up a public register after the completion of a ministerial review.

That development ties in, albeit not completely snugly, with a private member's bill that will be introduced to Parliament tomorrow. The Human Tissue (Organ Donation) Amendment Bill, which is sponsored by National MP Jackie Blue, would create an opt-on database of people who, on the basis of informed consent, wished to become donors. They could state which organs they wished to donate. The bill would also prevent anyone from overturning the wishes of a registered donor.

Doctors are adamantly opposed to the bill, describing it as unenforceable. But that view does not tally with the fact that similar law is being passed by an increasing number of American states. The bill, as Dr Blue concedes, has flaws in its present forms. It will be the job of a select committee, aided by the current ministerial review, to refine it. At the very least, the legislation provides a foundation for tackling the low rate of organ donation.

The doctors' opposition is understandable on one count. Legislation, by itself, will do little to lessen the delicacy of their encounters with distraught families. For that to happen, there must be early and more intensive discussion within families. Prospective donors need to let their relatives know they wish to donate. Families forearmed with that knowledge and insight would be far less likely to pressure medical staff.

In sum, the removal of the veto will be best for all concerned - donors, families and doctors. As will the replacement of a framework perched unsatisfactorily on the periphery of driver licensing. Organ donors deserve more than that, as do those awaiting life-saving transplants.

courtesy of the NZ Herald - www.nzherald.co.nz