[MUSIC] Consent is the second absolute rule for organ donation. Without it, organ donation is not ethically or legally permissible. To be valid, the consent must be informed, voluntary, and given by the appropriate person. Ideally, the wishes of the deceased should be known prior to their death so that their wishes can be honored. Organ donor registries function to do this. In South Africa, we have the organ donor foundation and similar organizations exist across the world. However they have a major limitation, in that unless legislation exists to support them, they are merely expressions of intent. When this is the case, or when the individual's wishes in respect to organ donation are unknown, the family is approached to act as a surrogate decision-maker to best represent the wishes of the patient. Even in countries where consent is presumed already valid, the family will be routinely sought out and approached. In South Africa in 2017, we have just over 200,000 people on the organ donor foundation registry, out of a population of 53 million. In the United States, ninety 95% of people are in favor of organ donation and yet only 48% are registered as organ donors, and only half of these have discussed organ donation with their family. I cannot stress enough how important it is to have these discussions with your family about organ donation, wherever you are in the world. Your family will always be asked for consent. In a time of severe distress, the default response is "No". But if you have primed your family about your wishes, when they hear the question, "What would you have wanted in this situation?", the answer is much more likely to be a "Yes". Informed consent in medicine explains the risks and benefits of a particular intervention to the patient. Only once you understand these risks and have freely agreed to them, is it considered informed consent. If I needed a cardiac bypass operation, I need to know the chance of death both with and without the operation. I also need to know the risk of a major disability, how long I will be in hospital, and what quality of life I can expect. An organ donation request is unique because when a patient is dead, there are no inherent risks to the patient. There is however always a family coming to terms with death and the consent process must supply them with adequate information about organ donation so they can make an informed decision. How we treat the patient and their family at the end of their life has an impact on what their decision will be. It is essential to be compassionate and understanding. At the heart of all consent is trust. For organ donation this is trust in the determination of death, trust that all required information is given and correct, trust that the donor will be treated with respect and trust that the gift of organ donation will be allocated equitably, fairly and that no one will profit financially. There is no cultural religion in the world that does not champion helping our fellow human beings and yet consent rates for deceased donation vary markedly between countries, and even within communities within countries. Some will say this is cultural or religious. Some will say it's related to socioeconomic factors or education levels, that we need to improve public awareness. I firmly believe it is up to doctors and nurses interacting with patients and their families at the end of a person's life to help change practices by being informed about organ donation and the processes involved. These interactions are where we can make a meaningful impact. How we treat patients and their families at the end of life has a huge impact not only for them at that moment but also for potential transplant recipients. Ultimately, organ donation always comes down to someone asking for and someone giving consent. We must make sure that we ask in the best possible way, at the best possible moment. Without consent, there can be no organ donation. [MUSIC]