For implementers, the locking model adds a fair amount of non-trivial internal bookkeeping. Every operation must check lock state, readers must be tracked, and the interplay between locks, cancellation, and error states creates a matrix of edge cases that must all be handled correctly.
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"What we've always said is talk to your loved one, make a decision and sign on the register, because we know when a patient has opted in and had those conversations, consent is much higher in those circumstances," said Harpreet Matharu, an organ donation specialist nurse for the NHS.