Who would you give your heart to?

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Who would you give your heart to?
More than 9,000 people in the UK need an organ transplant

8th January 2008

The current "opt-in" system of organ donation has been the subject of debate for many years, but just how serious is the shortage of organ donors in the UK?

More than 9,000 people in the UK need an organ transplant to save or dramatically improve their lives but the shortage of donors means that only around 3,000 transplants can be performed each year.

Around 1,000 patients die each year before receiving the second chance of life from an organ transplant.

Currently, individuals in the UK are asked to register their willingness to be a donor after their death by joining the NHS Organ Donor Register, carrying a organ donor card, or by discussing their wishes with those closest to them.

The British Medical Association, many transplant surgeons, and some patients' groups and politicians are keen to see Britain adopt a system of "presumed consent", where it is assumed that an individual wishes to be a donor unless he or she has "opted out" by registering their objection to donation after their death.

UK Transplant Managing and Transplant Director Chris Rudge comments: "In the past year, the Ministerial Organ Donation Taskforce has done a significant amount of work in identifying how the UK could dramatically improve the numbers of lives saved or transformed by organ transplants each year."

However, he does point out that: "Our rate of donation continues to lag behind many other European countries."

Therefore, perhaps it is time for the UK to change its policy on how the donation system works. If more people became donors, there would more organs available for transplants, and in theory more lives would be saved.

Figures show that on 31 March 2007, the number of people registering their wishes on the NHS Organ Donor Register stood at 14,201,229.

Two other systems of organ donation are used in current practice around the world – "opting out" and "required request".

Under a system of "opting out" or "presumed consent", every person living in that country is deemed to have given their consent to organ donation unless they had specifically "opted out" by recording in writing their unwillingness to give organs.

Supporters of such a system’s introduction in the UK argue that consent to donation should be seen as implicit and as the norm rather than the exception, as now, and that relatives or those close to a person who has not expressed a wish to donate, would be relieved of the burden of making that decision at such a traumatic time.

Opt-out systems can be "hard", as in Austria, where the views of close relatives are not taken into account, or "soft", as in Spain, where relatives' views are sought.

A policy of "required request" or required referral is operated in the United States. Required referral is defined: "that it shall be illegal, as well as irresponsible and immoral to disconnect a ventilator from an individual who is declared dead following brain stem testing without first making proper enquiry as to the possibility of that individual's tissues and organs being used for the purposes of transplantation".

The policy means opportunities for donation are less likely to be overlooked. Many individuals may be having their right to donate removed if their relatives are not approached. The next of kin also has a moral and legal right to know they can donate organs and tissue if they or the family so wish. Many families report that such a donation was helpful rather than harmful.

Although the introduction of this scheme saw an initial increase in the availability of organs, over time the numbers have declined.

Spain is recognised as having a higher number of donors than the UK and is the only country to sustain a year-on-year increase in organ donation for the last ten years. This followed the implementation of a comprehensive national procurement system.

However, Spain also has significantly higher road traffic accident deaths than the UK, suggesting that, even if the Spanish model was used in the UK, we might still not reach the same levels of organ donation as Spain.

Transplant services in the UK are renowned for the honest, open and transparent manner in which they operate. This is due, in part, to the fact that consent has always been an integral part of the process of donating organs for transplant.

The Human Tissue Acts introduced in 2006 reinforce the importance of consent for donation but make it explicit that it is the wishes of the deceased individual that should prevail. Many people have found it difficult to accept that relatives could overturn any wish they may have registered or expressed during their lifetime and the new legislation deals with those concerns. There is no evidence that a policy of presumed consent would increase the number of organs for transplant.

However, if organs are taken with only a presumption that it was someone's wish to donate, significant distress could be caused leading to a loss of professional and public confidence in what has hitherto been a transplant service operating with the highest integrity.

The important issue is that people discuss their desire to donate organs so that close family members and friends are aware of their wishes.

http://www.999today.com/healthandfitness/news/story/34342.html