Donation and transplantation: plan 2021 to 2026

Priority Seven – Public Health Improvement

While many people need transplants due to long-term medical conditions that could not be prevented, some develop organ failure due to factors which could have been avoided through a healthier lifestyle. For example, poor diet, a lack of physical activity, excessive alcohol consumption, smoking or drug use may all cause or contribute to different types of organ failure, such as liver, heart or kidney failure. Improving public health across Scotland should in the longer term both reduce the need for organ transplants, as well as reducing the incidence of other severe health conditions.

7.1Although a key focus of this plan needs to be on increasing the number of transplants available for patients in Scotland, it is clear that based on current numbers of potential donors as well as on the increasing need for transplants, at least for some organs such as kidneys, actions to increase living and deceased donor numbers and organ utilisation will not be enough on their own to allow organ supply to meet the current demand.

Scotland is already embarking on a process of public health reform with a key aim of improving public health across Scotland. A new public health body, Public Health Scotland, has been established to improve collaboration between the health service, local authorities, the third sector and other key stakeholders to promote healthier lifestyles and help tackle the main preventable causes of ill health. The reform process has identified six public health priorities^[8] which include priorities on: diet and physical activity; and the use of and harm from alcohol, tobacco and other drugs. Public Health Scotland will have a key role in supporting the delivery of the public health priorities, and so, as part of their long-term work, we will work with them to reduce the need for transplants, in the case of patients whose need for transplantation could be prevented.

We welcome the fact that the public health priorities are focused on health inequalities and aim to make sure that particular groups at higher risk or those who have so far been harder to reach with traditional messaging about health improvement are appropriately targeted. For example, we know that individuals from Asian communities are statistically more likely to develop conditions such as kidney failure and type 2 diabetes. Through the Peer Educator project with Kidney Research UK, there has already been considerable raising awareness of kidney disease amongst South Asian communities in Glasgow and Edinburgh. Work will continue to look at how best to improve awareness and encourage people in these communities to take action to avoid ill health.

The current reform of public health provides an important opportunity for public bodies and charities involved in public health to better align our collective efforts. We want to improve the health and wellbeing of the population by tackling poverty and reducing wider inequalities and the Public Health Priorities for Scotland, agreed with CoSLA, provide a focus for our national and local partners to work more effectively in partnership on key issues.

7.2 Alongside this, early diagnosis of patients with symptoms of organ damage or failure may allow patients to take positive action to improve their health, which could in some cases reduce their risk of their organ function deteriorating further and leading to them needing a transplant in the future. While medical professionals across Scotland already aim to identify organ damage at an early stage, work will continue to explore any practical actions to improve this further. As part of priority five on improving support for transplant recipients, transplant units and NHS Boards should also continue to support and encourage patients to follow the guidance they are given on diet, activity and any other advice to ensure their donated organ continues to function as effectively as possible and keep themselves healthy.