IT'S BEEN more than 30 years since the first donor organ card was introduced in Britain, giving people the opportunity to consent to donate their kidneys after their death. Yet despite dramatic advances in medicine, at least one person is still dying every day in the UK while waiting for a transplant.

While the majority of people say they back the idea of organ donation, statistics show that just 24% of people in the UK have actually signed up to the NHS Organ Donor register. It appears hundreds of opportunities to save a life are going to waste simply due to apathy.

It is a situation that has led to an increasing debate around the strength of the current "opt-in" system for organ donation. The British Medical Association (BMA) has led a sustained campaign to change to "presumed consent" for those over the age of 16, which would assume people are willing to donate their organs after their death unless they opt out. According to a survey published earlier this month by the BMA, nearly three-quarters of the public north of the Border also say they would support this system.

Last year MSPs failed to back such a change to the law and instead voted to strengthen the current system by placing more emphasis on following an individual's wishes on organ donation after their death in the Human Tissue (Scotland) Bill.

Now it appears there is increasing political backing for this move in Scotland. First Minister Alex Salmond and his deputy Nicola Sturgeon have both indicated their support at the SNP's annual conference, where a flurry of announcements on health were made yesterday. These included prescription charges in Scotland being cut by a "significant" amount from next April, and the maximum waiting time for hospital treatment being cut by six weeks by March 2009.

A "soft" system of presumed consent, which the BMA advocates, does not mean that the wishes of relatives are ignored, but the crucial difference would come in how they are approached by doctors. Instead of being asked if they agree to donating their loved ones' organs, they would instead be informed that their relative had not opted out of donation.

Unless relatives refused consent - for example, if they were aware of any unregistered wishes - the donation would proceed.

Many factors can impact on the rates of organ donations in different countries, such as the availability of intensive care beds and staff and the number of transplant surgeons. But one study last year concluded that, taking these factors into account, countries with presumed consent had 25-30% higher donation rates than those with an informed consent system.

However, in countries which have adopted presumed consent, including Spain and France, the rates of organ donation still vary greatly. According to a recent paper published in the British Medical Journal (BMJ), in Spain the donation rate was 35.1 per million population in 2005 - the highest in the world - but this dropped to 22.2 donors per million in France.

And in Austria, which has a more hardline approach - relatives are not asked for permission and are unable to refuse consent for organ donation - the rate was only 24.8 per million.

Writing in the BMJ, bioethicist Linda Wright, from the University of Toronto, concluded: "Donation will not increase without the necessary equipment, trained staff and intensive care beds to enable a potential donor to donate viable organs."

Charities and patient organisations, while backing moves toward a system of presumed consent, caution it will have to be supported by additional resources and major awareness-raising campaigns. Ben McKendrick, policy and public affairs manager at the British Heart Foundation Scotland, said: "We do have to ensure that there is the appropriate level of resources being made if the Scottish government is to take this further.

"We need to make sure health care professionals are being trained to have these very difficult conversations with people about organ donation.

"There also needs to be good communication set up to those who want to opt out, so they know how they go about doing that."

That is a view backed by Dr Keith Prowse, chairman of the British Lung Foundation, who said: "The decision to donate an organ is a deeply personal one and a system which presumes consent would have to ensure that people are clearly informed about their options."

One country which found presumed consent did not work was Brazil, which had to withdraw the system because it aggravated already high levels of mistrust in the country's medical system.

Dr Jean Turner, former MSP and chief executive of the Scottish Patient Association, supports presumed consent, but points out that sufficient "checks and balances" have to be in place.

"You would need to do an ongoing programme of advertising to people, so that it doesn't come as a surprise when people are ill," she said. "People are more supportive of organ donation, but they want the best treatment that can be given right up until the very end with no compromises."

She added: "If it was a member of your family, you would like to have more organs for donation - that is what it comes down to."

But there are others who strongly oppose the introduction of such a system of organ donation in Scotland. Lydia Reid, is chairwoman of Justice for the Innocents, which was set up in the wake of scandals where children's organs were retained by hospitals without consent.

She said she was "bitterly disappointed" by the SNP moves.

"If you are a doctor and have someone lying on the bed and have to make the choice between putting NHS resources into bringing this person back to life, or using their organs for transplant, what would be your choice?" she said. "If there is no relative or friend to look out for their interests, it is the doctor that makes that choice and it shouldn't be."

The Catholic Church is also opposed to the move, arguing that the proposal undermines the freedom of the individual and human dignity.

Spokesman Peter Kearney said: "We believe anybody's body after death should always be treated with dignity and respect and organs only removed if someone had explicitly agreed, or their next of kin or someone with power of attorney has done so. Their bodies are inviolable and shouldn't be tampered with or organs removed without their explicit consent."

Meanwhile, as the debate rages on, hundreds of people in Scotland are waiting for the call to give them a second chance at life. But with just 50 organ transplants carried out last year, the sad fact is that for many that call will come too late.