Organ Donation Teaching Resource Pack

Organ Donation
Teaching Resource Pack

Transplant Laws in the UK

Aims To make pupils aware of the present legislation governing organ donation and transplantation. To consider potential changes in the law to fit in with a European context. To raise discussion on some moral issues within each position.

Legislation

Two key laws govern organ donation and transplantation:

• The Human Tissue Act 1961;
• The Human Organ Transplants Act 1989.

The Human Tissue Act

The Human Tissue Act 1961 defines how an organ and tissue donor is identified.

The Act states that if a person has expressed a wish in writing, or orally in the presence of two or more witnesses during his or her last illness, that their body or any specified part may be used after death for therapeutic purposes or for medical education or research, the person lawfully in possession of their body may, unless there is reason to believe the request was subsequently withdrawn, authorise removal from the body of any part, in accordance with the request.

At present, a person must express their wish to be a donor in writing or verbally to two or more witnesses. This system is commonly known as 'opt-in'. A person who wishes to 'opt-in' puts his/her name on the NHS Organ Donor Register, maintained by NHS UK Transplant. This is a national, confidential list of people who are willing to become donors after their death. It can be quickly accessed by transplant co-ordinators to see whether an individual has expressed willingness to be an organ donor.

If there is no evidence of such a wish, the person lawfully in possession of the body may still authorise the removal of any part from the body provided that, after making reasonable enquiries, he/she has no reason to believe that the deceased had expressed an objection or that the surviving spouse or any surviving relative objects.

The Human Organ Transplants Act

The Human Organ Transplants Act 1989 makes any commercial dealings in human organs for transplant a criminal offence.

It is also an offence to advertise the buying or selling of organs or to withhold information required by law about transplant operations.

The Act also makes it illegal to transplant an organ removed from a living person unless the donor and recipient are genetically related.

The legislation was accompanied by The Human Organ Transplants (Unrelated Persons) Regulations 1989 which, subject to certain conditions, allow donation between donors and recipients who are not genetically related. This might include, amongst others, partners, husbands and wives.

The Unrelated Live Transplant Regulatory Authority (ULTRA) was established by the 1989 Regulations and its role is to be satisfied that certain conditions have been met before transplants between persons who are not genetically related will be allowed. It is concerned to ensure that no payment or inducement has been made or offered, and that no pressure has been put on the donor. The Authority will also want to be certain that an independent doctor (that is one not involved in the transplant) is satisfied that:

• no payment is involved;
• the case is being referred by the doctor with clinical responsibility for the donor;
• the donor is aware of the nature of the operation and the risks involved;
• the donor's consent was not obtained by coercion or the offer of an inducement;
• the donor understands that he or she can withdraw at any time before the operation.

Further information on the legislation is available from:www.uktransplant.org.uk

Millions of people carry donor cards which indicate a willingness to donate organs in the event of death. Carrying a donor card has no legal validity and does not allow organs to be retrieved automatically.

When a donor card or register enrolment form is signed it is also very important that close relatives or those closest are informed of this decision. Even if a name is on the register or a card is carried, relatives are still consulted; so it is important that they can provide information about the donor's wishes. If the person who has died did not carry a donor card, or had not added their name to the NHS Organ Donor Register, their family will be asked what they think the person's wishes would have been.

No conditions can be made by the donor or their family about who they want to receive any organs donated. The organs are allocated to whoever is the best match throughout the country.

Discussion point Should people be able to attach conditions to organ donation?

Figure 1 - The Stages in Becoming a Donor

It cannot be overstated that an individual must communicate to their loved ones their willingness to donate organs in the event of their death.

There are many who believe that it is time to change the law from the 'opt-in' position.

Consider the various possibilities for discussion.

Compulsory Donation

Some would say that as the organs are of no use to an individual once dead, it should be mandatory that they are retrieved and used to save the lives of others.

Discussion point Is it right that healthy organs are buried in the ground or cremated with the body if they could be transplanted?

'Opt-Out' (Presumed Consent)

Another argument put forward is that instead of 'opting-in' an individual would 'opt-out', that is someone's organs would be retrieved automatically unless he/she had indicated an unwillingness to donate organs after death.

There are two different forms of 'opt-out':

a. organs are retrieved regardless of the wishes of the family, unless the person had registered an objection ( hard opt-out);
b. in the absence of any declaration from the deceased, the issue of donation would be discussed with the family ( soft opt-out).

This is a very emotive subject, and bad publicity from families in such situations might affect the overall attitude of the public to organ donation and transplantation.

International Comparison

Currently there are 14 European nations operating under a system of 'presumed consent'.

Austria
Belgium
Czech Republic
Finland
France
Greece
Hungary
Italy
Luxembourg
Poland
Portugal
Slovak Republic
Spain
Sweden

Argentina, Brazil and Chile have transferred to this system as well. All of these nations have adopted the system of 'presumed consent' in the last 30 years.

Some, like France and Belgium, operate a soft 'opt-out' system, which requires that a reasonable effort be made to determine the wishes of the deceased (if not obvious) by conferring with family, friends or checking the register.

Required Request

This refers to a requirement for staff in intensive care environments always to ask the family for permission for organ donation when medical treatment has stopped and death has been confirmed by brain stem tests.

At present it is at the discretion of the medical staff whether to approach the family with a request for organ donation. There may have been occasions when organ donation was not considered, and families were not approached, therefore denying them the right to make a decision about organ donation.

In the USA it is the law that a request for organ donation must be made, if appropriate, after death.

All of these issues relate to 'cadaveric donation', the retrieval of organs from someone who has died. There is clearly the potential for tension between fulfilling the wishes of the person who has died, and respecting the feelings of the family, who have just lost a loved one.

Some organs can be donated by people who are still alive, and living donation is discussed in the section on kidney transplantation.

Tasks and Discussion points In your own words, state what the following terms mean: Opt-In; Opt-Out (Presumed Consent); Soft Opt-Out; Hard Opt-Out; Compulsory Donation; and Required Request. Discuss with your group possible problems associated with each of these positions eg, some believe that if they carry an organ donor card when admitted to intensive care, doctors will not treat them as well as they might in order to gain organs. Another problem to discuss is what rights do you have as a 'dead person'. Some believe that as you cease to exist, you have no rights. Others believe that you have the same rights as when alive. What do you think?

I am interested in giving blood, what do I do?

Blood is needed constantly, for all kinds of things, such as cancer treatments, operations and in childbirth. There are thousands of places all over the country that hold blood donor sessions and new blood donors are always welcome. For further information on where to give blood. Almost anyone aged 17 to 60 years and in general good health can give blood.