Organic harvest

Rhys Thomas played rugby for Wales seven times. Now, aged 33, he cannot climb his own stairs.

Since suffering a heart attack in 2012, Thomas has lived permanently attached to a ventricular assist device, which supports his heart function and blood flow. 'It is a huge restriction to my everyday life,' he says. He has been on the heart transplant list for eight months.

Last week, he hailed a 'giant step' designed to reduce the wait, as the Welsh government introduced a 'soft opt-out' system for organ donation. Doctors will now presume adults have consented to donate their organs when they die unless they have expressed their wish not to do so.

The move is designed to boost donation rates and save lives. Health minister Mark Drakeford says: 'There are many people who would be prepared to be organ donors but the knowledge of their wishes is not available.'

Wales is the first part of the UK to depart from the 'opt-in' system, under which only those who express their desire to donate while alive are considered. But their decision could have a knock-on effect.

Yesterday, Scottish health minister Maureen Watt said she would pay attention to Wales's scheme and she was not opposed to an opt-out system 'in principle'. NHS Blood and Transplant has called for a nationwide 'revolution in public behaviour'; 6,000 people, including 270 children, have died while waiting for the transplant across the UK in the last 10 years. But taking organs from the recently deceased is difficult - of the 30,000 people who die in Wales each year, only 330 are able to donate them.

The NHS currently performs transplants of seven organs and various kinds of tissue. The World Health Organisation says there is evidence that presumed consent improves donation rates. And a study in 2014 suggested that countries with 'opt-out' policies had higher overall rates of organ donation than those without them - but lower rates of donation from live patients.

Bravo, say supporters. When we die, we no longer need our organs. It is the height of selfishness to withhold them from others whose lives may depend on them. Those who refuse to donate are simply indulging themselves in a pointless final act of individualism.

That is totalitarian, respond opponents. For the state to assume control over our bodies shows a fundamental misunderstanding of death - the most private experience of all. Our bodies belong only to us in life, and they are the only earthly possession we retain in death.

Perhaps, respond others, we should treat organ donation as a two-way contract. If you are unwilling to give an organ, that is fine - but do not expect anyone else to give you theirs if you need it.