Organ and tissue donation and transplantation: consultation

Footnotes

1. While most donate fewer organs, it is possible for one patient to potentially save or transform the lives of up to 9 people: 2 kidneys, heart, 2 lungs, pancreas, small bowel and 1 liver, which can in some cases be split in two and transplanted into 2 people (this does not include lives saved or transformed by tissue donation)

2. Taking Organ Transplantation to 2020 - A UK Strategy notes that over half a million people die each year in the UK, but fewer than 5000 people each year die in circumstances or from conditions where they could become donors.

3. Source - NHS Blood and Transplant ( NHSBT)

4. For example, in a survey of 1032 people in Scotland in August 2016 carried out by TNS, 70% of people agreed that ' we should all register to be organ donors'

5. See Council of Europe Transplant Newsletter September 2015: https://www.edqm.eu/sites/default/files/newsletter_transplant_2015.pdf

6. See https://www.ipsos-mori.com/researchpublications/researcharchive/3728/Wishes-of-organ-donors-should-take-priority-over-wishes-of-their-families-public-says.aspx - a survey of 1001 adults in Great Britain (but this does not provide a breakdown of responses provided by those in Scotland). 49-50% favoured the current opt in model, while 37-42% favoured an opt out/deemed consent model.

7. Source - NHS Blood and Transplant ( NHSBT)

8. For example, in 2014, an average of 24% of donated kidneys in Spain were not used for transplant because no transplant centre would accept them. This is compared to only 10% in the UK because in the UK no organs are removed from a donor unless they have already been accepted by a transplant hospital as being suitable for one of their patients.

9. Note - this is just a summary of steps and steps 2 and 3 would be considered at the same time. Authorisation procedures would not be taken forward in cases where there were already known medical reasons why the person could not be a donor. These procedures would also not be taken forward if the Procurator Fiscal refuses to consent to any donation - NHS staff must inform the Procurator Fiscal under certain circumstances, such as if the death was suspicious.

10. See the Human Transplantation (Excluded Relevant Material)(Wales) Regulations 2015 at http://www.legislation.gov.uk/wsi/2015/1775/pdfs/wsi_20151775_mi.pdf

11. Note - this flowchart is based around donations of 'standard' organs and tissue for transplantation - it does not cover either donations for research or the proposals around rarer types of donation - in both cases explicit authorisation from either the donor or their family would be needed.

12. Survey of 1032 people by TNS on behalf of the Scottish Government as part of the Organ Donation 2016 campaign evaluation - 70% agreed with the statement " as organ donation saves lives, we should all register to be organ donors"

13. Note - this issue does not apply in the same way for donors who donate after being diagnosed as brain-stem dead ( DBD donors). While tests also need to be carried out on DBD donors, they are only done after it is confirmed that the donor is dead.

14. Currently in Scotland these tests are not required for DCD patients as hearts are only donated by patients diagnosed as brain-stem dead. However, DCD heart donation has been trialled in some hospitals in England and might potentially be extended to include some Scottish donors in future.

15. For example, a patient may be given a drug such as Noradrenaline to improve their blood pressure - maintaining or increasing the dose of this after the decision has been taken to withdraw life sustaining treatment will help improve the blood flow to the organs. If antibiotics are used to treat an infection which the donor has, that will help mitigate any impact of the infection on the organ transplant recipient(s)

16. See the NHSBT policy note at http://www.odt.nhs.uk/pdf/contraindications_to_organ_donation.pdf

17. For example there are some existing guidance documents which set out suggested clinical triggers for considering donation, such as the National Institute for Health and Care Excellence ( NICE) guidance for England on improving donor identification https://www.nice.org.uk/guidance/cg135/chapter/1-recommendations

18. Note - outside the central belt of Scotland, currently heart valves and corneas are the only tissue that can be donated. Within the central belt, tendons and skin can also be donated.

19. Currently in Scotland these tests are not required for DCD patients as hearts are only donated by patients diagnosed as brain-stem dead. However, DCD heart donation has been trialled in some hospitals in England and might potentially be extended to include some Scottish donors in future.

20. For example, a patient may be given a drug such as Noradrenaline to improve their blood pressure - maintaining or increasing the dose of this after the decision has been taken to withdraw life sustaining treatment will help improve the blood flow to the organs. If antibiotics are used to treat an infection which the donor has, that will help mitigate any impact of the infection on the organ transplant recipient(s)