Although 9.2 million people in this country carry organ donor cards, there are still more than 6,000 people waiting for transplants.This week is National Transplant Week and here Frank Elson examines the campaign to boost the number of donors.

IN this country, it is difficult to avoid being asked to carry the card. There is an "opt in" box, which needs to be ticked, with every new driving licence and a donor leaflet is sent out with every new passport.

However, there is a growing movement that argues that rather than opting "in" our organs should automatically be available for transplant unless we opt "out". This system works very well in Spain.

A huge majority of people, 70 per cent of the UK population, agree with organ donation but, for a variety of reasons, only 15 per cent get round to carrying a card themselves.

Yet others, like Zoe Greenhalgh who was featured on the Bolton Evening News' front page yesterday, are determined to leave the gift of life for others. Zoe is dying from an inoperable brain tumour and has decided to leave her body to medical science. She is urging people to carry donor cards as part of a nationwide campaign.

A spokesman for UK Transplant, an organisation devoted to increasing the number of donors, said: "Transplants are one of the most miraculous achievements of modern medicine, but they depend entirely on the generosity of donors and their families. Research shows that many people mean to obtain a card but put it off. An opt out system would save many more lives."

In this country you are much more likely to need a transplant than become an organ donor. Supporters of the opt in system further argue that if you would accept a transplant, you should also be willing to be a donor. One donor can give life to several others and restore sight to two more.

In the Bolton area there is another issue which needs to be addressed. Although cross-race transplants do work there is a higher chance of a tissue match within ethnic groups, so that, although a Caucasian can donate an organ to an Asian successfully and vice versa, the odds for a match are higher from within the same ethnic group.

It is now known that some ethnic groups are more likely to be prone to kidney disease. As a result even more donors are needed among these groups.

But why do we need so many potential donors when there are 9.2 million carrying cards?

Put simply, and a little crudely, enough of us are not dying in the "right" circumstances.

Transplants are now so successful in the UK that many more patients can be considered for treatment in this way. As a result waiting lists are growing at a faster rate than organs become available.

Not everyone who has expressed a wish to be an organ donor will die in circumstances which make donation possible. The cause and place of death is important.

Most organ donations come from patients who are certified brainstem dead while in a hospital's intensive care unit -- and car accidents are by far the greatest cause of head injuries which cause death in this way.

Donor card carriers must, also, make sure that they have spoken to their nearest relatives and made their wishes very clear. Currently around 25 per cent of relatives refuse to give permission for organ donation -- even if their relative carried a card -- and doctors are extremely reluctant to go against such wishes.

On the other hand, Organ and Tissue Donation Liaison Sister at Bolton Royal Hospital, Fiona Wilkinson, said: "Many relatives say afterwards that agreeing to an organ donation and knowing that someone else has been given life often helps to ease their grief." Fiona's job is to train hospital staff in the often difficult job of approaching relatives: "It is our duty to ask for a donation," she added, "but it is often difficult for hospital staff to approach relatives at a time of grief. At Bolton we carry out corneal transplants and I cannot stress enough what the joy of sight brings to people." Transplant technology has increased at a tremendous rate since the first cornea transplant -- in 1905! Today, kidneys, heart, liver, lungs, pancreas, small bowel, corneas, heart valves and bone can all be used. Skin can be used to treat patients with severe burns.

The safeguards are carefully constructed. Two doctors have to carry out a series of tests independently in order to confirm that a patient is brainstem dead. The standards are strict and are accepted medically, legally and ethically. If, despite their efforts, the patient dies, only then can organ donation be considered. Organ donation registration cards can be obtained by telephoning 0845 60 60 400 or register online at www.nhsorgandonor.net

VITAL ROLE: Fiona Wilkinson who trains staff on how to approach relatives when a loved one could be a donor