Nailing his colours to the mast on the subject of organ donation, the Archbishop of Wales has spoken out against plans to have 'presumed consent' recently. In Wales (as in the rest of the UK) individuals have to either sign a national register or carry a donor card in order for their organs to be donated after death to opt in. However the proposed changes would mean that individuals need to sign a register to ensure that their organs are not donated upon death. In other words, they need to 'opt-out'.

The debate in Wales over a change to an 'opt-out' system can be traced back to 2008. Although the National Assembly's Health Committee decided against recommending a change in legislation in September of that year, Health Minister Edwina Hart and other AMs rejected their findings, stating that the evidence received was not fully reflected in their report.

Extensive public consultation followed with a high level Welsh campaign on kidney donation adding to the mix. This period of consultation led to First Minister Carwyn Jones stating last year that he would seek powers in order to introduce presumed consent legislation in Wales, saying that it was what the majority of the people of Wales wanted. With a White Paper on the proposals expected before Christmas, the issue is clearly not going to go away.

'Opt-out' advocates argue that hundreds of people in Wales are on waiting lists for organs at any given time, with some waiting months and others dying as a result of the lack of organ donation. They also point to a discrepancy in the number of people who are in favour of organ donation according to surveys - about 90% - to the number who actually get around to opting into the system - 28%.

Critics of the proposed legislation argue that a change in the law will not guarantee an increase in organs donated. This is surprisingly true, according to statistics from the 24 countries that operate some form of presumed consent system. However, the reasons why statistics in opt-out countries don't show a clear rise in organ donations are complex and to conclude that presumed consent is undesirable because numbers of organ donations have not risen in these countries is simplistic.

In his Presidential Address to the Church in Wales governing body, the Archbishop of Wales, raised concerns about the proposed system, saying that the subtle shift in relationship between the citizen and the state meant that the state became the owner of bodies of the deceased. Moreover, the donation of organs in the current opt-in system was a sacrificial gift of love and charity, a dynamic that would change, he argued, with presumed consent.

The issue has been debated at length in medical journals with many highlighting different ethical concerns to presumed consent. Recent Christian voices on the subject including Care, the Christian Medical Fellowship and Archbishop of Wales have come out against an opt-out system. However, a recent straw poll of Christian health specialists in Wales found both those in favour and against.

The issue is not primarily theological but medical and ethical and it is important that we allow the debate to evolve and develop within Christian circles. Given a full airing, it is likely over time that, once the dust has settled, we will see a broad range of Christian perspectives on this issue.