Like McCaughan1, we are both in the unfortunate position of owning and driving a car in NSW, and have therefore faced the frustration associated with licence renewal. We consequently agree that any system that attempts to provide an opportunity for discussion of organ donation would need to be carefully thought through, systematically organized and appropriately funded. We accept that our paper did not provide the costing and administrative detail that would be necessary for our proposal to be turned into policy. Nonetheless, it is feasible that a model of a 5-min discussion with only those licence holders who refused donation would come in well under the $13.4 million allocated for public awareness and education in the Australian ‘World's Best Practice (WBP) Reform Plan’2. While in general terms we are supportive of the WBP approach, it is worth pointing out that none of the countries with leading organ donor rates uses the model described by McCaughan; that there are important differences between the ‘Spanish Model’ and what is referred to as WBP (differences that may ultimately compromise the success of reforms of organ donation in Australia); that WBP is modelled after countries who are all, with the exception of the USA, opt-out countries – thereby negating the necessity for registration of donor intention; and that regardless of the approach they have taken very few countries have achieved donor rates of 25–35 p.p.m. (only Spain, Belgium, Portugal and occasionally the USA)
