对48个国家的器官捐赠方案的分析已经出版于BMC医学今天, studying the differences between opt-in and opt-out systems. In this guest post, Sally Johnson, Director of Organ Donation and Transplantation at National Health Service (NHS) Blood and Transplant, tells us about why we need more people to consent to organ donation.

As director of Organ Donation and Transplantation at NHS Blood and Transplant I’m delighted to have seen huge increases not just in the numbers of deceased organ donors over the last few years, but also in the numbers of patients benefitting from a transplant.

However, I want to explain why we can’t rest on our laurels and why we still have a huge amount of work to do if we are to change public attitudes to organ donation and bring about an increase in consent rates.

已经取得了进展

But before I do, I want to paint a picture of the progress that’s been made. The UK has taken a huge leap forward in organ donation and transplantation rates over the last few years. The number of deceased organ donors has increased from 809 in 2007/8 to 1,320 in 2013/14. The number of deceased donor transplants increased from 2,384 to 3,509 over the same period. What this means is that more people are getting the transplant they need than ever before.

这些数字反映了NHS在嵌入死者捐赠实践中发生的大量工作和转变。现在，在所有急性信托基金会和医院团队中都存在器官捐赠的临床潜在客户，以识别潜在的捐助者，并将其转介给NHS Blood和Transplant的器官捐赠专家护士团队。

Quality training materials and theNational Institute of Health and Care Excellence (NICE) guidance on donor identification and consent为了确保以适当和敏感的方式与家庭联系。

We have also established a National Organ Retrieval Service to ensure that there are surgical teams available whenever and wherever a family agrees to donation so their organs can benefit patients.

I think that the NHS has done almost all it can do to build an infrastructure that supports an effective donation and transplant system, making the most of every donation opportunity. But this is not enough.

More lives can be saved

在强调这一重要进度时，我们永远不应该忽视的是，英国的三个人每天都需要器官移植。除非我们看到公共行为的地震转变和更多潜在的捐助者同意器官捐赠的家庭，否则在患者获得可以改变生活的器官之前，会有更多的人死亡。

您可能会想知道，当NHS器官捐赠者注册册上有数百万人（实际上有2000万人）时，为什么同意如此重要。许多人决定在死亡时想帮助他人，对吗？

Yes, that’s right and that’s great! But the challenge is that only around 5,000 people of the half a million people who die in the UK each year die in circumstances where they could potentially donate their organs.

家庭同意是关键

This figure means that every single potential donor is precious. Many of these potential donors are not on the Organ Donor Register and even when they are, their families when approached may find it too difficult to agree to donation going ahead, often due to grief and the fact that they may not fully understand what the donation process involves.

他们也可能不得不从头开始做出决定，因为他们所爱的人不在登记册上，他们根本从未讨论过作为家庭的捐款。这可能会使家人承担不得不猜测亲人在艰难时期想要什么的负担。

Sadly, the impact of all is this is that four out of ten families approached say no.英国对器官捐赠的家庭同意率仍然固执地较低。不幸的是，如果家庭不对捐赠说“是”，他们所爱的人的器官将被埋葬或火化，其他等待移植的患者也可能死亡。

这更令人沮丧，因为英格兰82％的人说他们肯定会或考虑捐赠其某些器官。

没有“魔术子弹”来解决英国同意率低的问题。显然，我们需要一场公共行为革命，人们做出积极的决定，与家人捐款并讨论这一决定。

What is very clear is that we need to continue working closely in partnership with the UK health departments, other UK Government agencies and the voluntary sector in order to bring about the necessary change in attitudes.

I am really encouraged to see that many of these partnerships are making a positive difference, for example our successful work with the DVLA (Driver and Vehicle Licensing Agency) and theBehavioural Insights Unit鼓励器官捐赠者注册注册。但是我们知道需要做更多的事情。

明年，威尔士将转向新的立法系统，人们选择注册为捐助者，记录一个决定不做捐助者或不采取行动的决定，并被视为已同意捐款。我们所有人都非常感兴趣地观察该计划对捐助者数字和同意率的影响。

We need greater awareness and discussion

我要什么？我们需要医院继续识别和推荐潜在的捐助者。我们知道，我们的重症监护小组和急诊部门的同事承受着压力，但我们确实需要他们关注球以捐赠。

Every hospital has patients waiting for transplants, so any decision not to refer will have wider implications. Too many patients continue to die needlessly when waiting for an organ transplant, while others are forced to continue with treatments which greatly restrict their quality of life.

我们在这个国家（毫无疑问，在其他国家也需要），每个人都必须做出积极的决定来捐赠，注册器官捐赠者登记册，最重要的是，告诉他们的亲人他们想捐款。

Surely there is nothing you can be more proud of than saving lives after your own death? And don’t we also have a societal responsibility to save lives if we can?