Organ donation
Registration
- There is a computerised national NHS Organ Donor Register run by NHS Blood & Transplant (NHSBT)
- Children can be registered by parents
- Donor cards
- Available in GP surgeries and hospitals
- Not publicised now as they can be lost or left at home
- Direct registration
- Online at www.organdonation.nhs.uk
- Phone/email/text services available
- Driving licence
- From August 2011, anyone applying for a new or replacement licence must answer question about whether or not to be on the Register
- Other methods of registering
- Asked when registering at a GP surgery
- Asked when applying for a European Health Insurance Card (EHIC)
- Organs/tissues covered
- Head: Eyes
- Chest: Heart, lungs
- Abdomen: Kidneys, liver, pancreas, small bowel
- Other tissue: Skin, bone, tendons, etc
- Not blood or bone marrow (there is a separate British Bone Marrow Registry)
- Recipients
- Donors cannot specify any restriction on potential recipients
- NHS patients take priority for any donated organ
- Other patients not eligible for NHS care or other European patients may be offered organs if there is no UK match
Validity of registration
- If the patient has a signed organ donor card or on the NHS Organ Donor Register, then the organs may be removed regardless of relatives’ wishes.
- But note that the next-of-kin is asked if the patient had changed their mind about donation since signing up to the register.
- If the patient has made no wish, then people with a ‘qualifying relationship’ can be asked (in the order below) for permission
- Qualifying relationships
- Nominated next-of-kin
- Spouse
- Parent/child
- Brother/sister
- Grandparents/grandchildren
- Nephews/nieces
- Half-brother/half-sister
- Longstanding friend
Procedure for organ donation
- Hospital team check the NHS Organ Donor Register for any patient who is brainstem-dead
- Specialist Nurse Organ Donation (SNOD) is contacted (formerly the ‘transplant co-ordinator’) for any potential donor
- If not on the register, then the patient’s organs can be removed if:
- The deceased patient had no known religious objections or other objections to donation
- The family have no objections
- The SNOD will take a brief medical history and review medical records
- Absolute contra-indications to organ donation for transplantation
- HIV
- New variant CJD
- Relative contra-indications
- Active TB
- Malignancy
- Sepsis
- Blood is taken for:
- Matching
- Blood grouping
- HLA-typing (Class I and II)
- Viral serology
- HIV, hepatitis B, hepatitis C, CMV
- Organs are removed and stored in a tissue bank or transported for immediate transplantation
- Computer allocation to best match locally or nationally by:
- Blood & HLA matching
- Age & size matching
- Distance of recipient’s hospital to donor
- Time on waiting list
Transplantation risks
- Transplant operation risks
- Donor organ failure/rejection
- Immunosuppressant therapy risks (side-effects, infection, cancer)
- Transmissible infections from donor
Human Tissue Act 2004 (2006 in Scotland)
- In response to scandals in which some hospitals were found to have stored organs without the permission of patients or their relatives (eg. Bristol Royal Infirmary, Alder Hey)
- Consent is now needed for:
- Hospital post-mortems
- DNA analysis from tissue
- Research
- Transplantation
- Anatomical examination (eg. medical schools)
- Public display of specimens
- Consent is not needed for:
- Coroner’s post-mortem
- Tissue removed routinely during surgery (eg. appendix)
- Consent is given by the patient, or if deceased then someone with a qualifying relationship (see ‘Registration’ above)
- Human Tissue Authority has been set up to monitor the law and organisations storing tissue now need an annual licence to do this
Living donation
- Living organ donations can include a whole kidney, or rarely part of a liver or part of a lung.
- Most commonly, this is performed between family members or partners.
- Altruistic donations are allowed by the Human Tissue Act 2004
- These are donations to an unspecified stranger
- Is only possible after a psychiatric assessment!
- Medical issues
- Blood group matching is the first step
- If incompatible, then the donors can participated in a pairing/pooling scheme
- Donor assessment
- Medical history
- Viral serology for HIV, hepatitis B, hepatitis C, CMV
- General health
- Chest x-ray, ECG, echocardiogram, routine blood tests
- Kidney function
- Urine biochemistry/microbiology
- Renal function test
- Creatinine clearance
- Radioisotope-based
- Renal ultrasound
- Renal angiogram
- Pairing/pooling scheme
- If a donor and recipient are incompatible, then they can be matched to another incompatible pair, so that each donor is compatible with the other pair’s recipient
- This can also be done in a bigger ‘pool’ involving multiple incompatible pairs with different blood groups
- Legal issues
- Donor cannot be coerced into organ donation
- No payment can take place, but donor expenses can be covered by the hospital
- The donor and recipient cannot exchange any money at all
- The Human Tissue Authority assess if a living organ donation is legal after medical matching
Ethical issues
- Autonomy: Individuals have the right to decide what happens to their body. Overrides relations if on Register or documented legally.
- Social justice: Organ donation will save others’ lives.
- Beneficence: Again, organ donation will help another patient. Of course it is of no benefit to the donor.
- Non-maleficence: Relations may be upset by the thought of organ donation.
Further reading
NICE guidelines on organ donation:
http://guidance.nice.org.uk/CG135
Summary of Human Tissue Act 2004, Department of Health:
http://www.dh.gov.uk/assetRoot/04/10/36/86/04103686.pdf
