AND so the hard work well and truly begins...

It may have taken several years for the idea of an opt-out system for organ donation in Wales to become a reality.

But however long and tortuous the path from proposal to law, however much wrangling and debate there has been, the success of the Human Transplantation (Wales) Bill will largely depend upon what happens during the lead-in period.

The Bill passed in the Assembly last week is likely to receive Royal Assent late in the summer, and there will then be a two-year preparation time, with an ongoing awareness campaign to inform people of the impending change in the system.

This week is National Transplant Week, an annual awareness campaign run by NHS Blood and Transplant, which focuses on urging members of the public to discuss their donation wishes with their loved ones, and asking people to join the Organ Donor Register.

It carries extra weight in Wales this year in the aftermath of last week’s historic vote in the Assembly. But from the autumn in Wales, to these two key messages will be added the task of explaining again and again how the new optout organ donation system will work.

Fundamentally, from a date yet to be fixed in autumn 2015, unless a person has formally objected during their lifetime to donating all or some of their organs in the event of their death, it will be presumed they have consented to those organs being donated.

Currently, you have to opt in to organ donation, through the register or by carrying a donor card.

But under the new system, if you do not register an objection to organ donation, you will have been presumed to have consented.

This is an idea that seemed to have captured the imagination of people in Wales. Last spring, almost two-thirds of people asked in a survey said they were in favour of an opt-out system, or presumed consent, for organ donation.

Recently however, things have not appeared so clear cut. By last October, 49 per cent were in favour, with 22 per cent against, 21 per cent needing more information, and eight per cent undecided.

And organ donation rates in Wales fell last year despite increasing in other parts of the UK.

Opponents of presumed consent have seized on the latter as evidence that presumed consent, and even talk of it, will damage organ donation rates. Supporters meanwhile, cling to the more psoitive evidence.

Whatever the true picture, it is undeniable that many concerns remain, with the role of the potential donor’s family a key issue.

Opponents, led during the final Assembly debate on the Bill by ConservativeAMand shadow health minister Darren Millar, argue that a so-called ‘soft’ opt-out system proposed during the formulation of the legislation, offering families a say in what happens, has been diluted.

Supporters, not least Assembly health minister Mark Drakeford, insist the family has a role, but as he stressed during that debate, “family involvement is only on the basis of the known views of the deceased, not the views of family members.”

For those who think presumed consent is a good thing, this is a fundamental point. The new system aims to increase the amount of organs available for transplant, and their great fear is that too much weight on family views in what are already extremely stressful circumstances, would frustrate this goal.

Sensitivity at such a time is also vital too however, and clinicians involved in making decisions on donation will have to tread especially carefully. Some potential donations may not go ahead because family distress will be great enough to rule them out.

Arguments over presumed consent will continue, but for all practical purposes, the focus must shift.

Preparing the people of Wales for a fundamental change in health policy is now the paramount concern.

For all the millions of pounds that will be spent - over a 10-year period covering the lead-in and postimplementation, it is projected that around £4m will be spent on communication - there will still be many people who do not address this issue with their loved ones, or take steps to make their wishes known as individuals. There will remain people who still do not understand the implications of the new system, or even, despite all the publicity, know about it. The debate preceding the passing of the Bill last week went on long enough into the night that with the lights set to go off automatically at 10pm, the Senedd faced being plunged into darkness if it went on much longer.

There has been much congratulatory talk since the bill was passed about how it demonstrates that Wales is a progressive nation able to make bold decisions which will make a difference to people’s lives.

Fair enough.

But how its people are prepared for and informed about presumed consent during the next two years, will be just as important a measure of progression and boldness.

Just like AMs in the Senedd, it is vital they do not kept in the dark.