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The Demand for Human Organs

The organ donor system has come under intense review of late, partly as a result of some very prominent press stories, including the request of an organ donor that his organs be donated only to a white person, and the discovery that some hospitals in Britain were using organs of deceased patients without the permission of relatives. The following article, reprinted with kind permission of THE WEEK, (17 July, 1999), examines the system and looks at the arguments for reform.

How many people in Britain need organ transplants?

At present, more than 6,700. Kidney transplants are the most in demand, with 5,817 people regularly using a kidney dialysis unit while they await a spare kidney; 233 people are waiting for livers; 9 people for a pancreas; 257 for a heart and 120 people for both heart and lungs.

And is that need satisfied?

No, because the average number of donors each year is fewer than 1,000. Last year, when there were only 847 donors - the lowest number in ten years - 200 people died while on the waiting list. And the long wait for a suitable organ - the average wait for a new kidney is 492 days - is getting ever longer. One of the organ transplant industry's primary sources is fatal car accidents, but these have decreased by nearly two thirds since the Eighties.

How does one become a potential organ donor?

There are three ways: signing an organ donor card, registering on the Organ Donor Register and, most importantly, telling your relatives you wish to be a donor. However, although donor cards have been around for nearly 30 years, they are only carried by one third of the British population. If any of these suddenly die, their organs can be used for transplants.

Does the family of the donor have to be consulted?

Technically, no. Under the 1961 Human Tissues Act, hospitals can authorise the removal of a person's organs provided that he has recorded his wish to donate them and there is no reason to suppose he has subsequently changed his mind. But in practice doctors feel they need the express permission of the family before proceeding. In the case of Leah Betts, for example, who died of a kidney failure two years ago after taking ecstasy in a nightclub, her family's permission was considered essential. Her organs were given to eight different people. However, in one in every three cases where the deceased has not recorded a wish to be a donor, bereaved relatives refuse permission.

Can donors impose conditions on who gets their organs?

The 1961 act does not rule it out, but the British Transplantation Society guidelines recommend that donors should not be allowed to do so. Sometimes, however, they do. A non-smoking family will ask that their relative's lung not be transplanted into the body of a smoker. In the Sixties, many Irish Protestant and Catholic families refused to allow their organs to go to people of the other religion. Some Muslims insist that only Muslims should be recipients. But the NHS Organ Donor Register specifically excludes any donor who wishes to attach conditions about who should receive their organs. That is why the decision of an NHS staff member to record the request made by a donor's family in Sheffield - that his organs not be donated to "a coloured person" - has caused such controversy.

Do racial differences affect the chances of success?

It's not strictly speaking skin colour that matters, but blood and tissue types. Unless the donor's match the recipient's, then the recipient's body will reject the transplanted organ. But since tissue types tend to vary according to ethnic group, race in the end does tend to make a difference. This is borne out by the statistics which show that transplants have proved to be more successful between people living in the same communities, the same area and of the same race. In practice, however, it is difficult to match people on these criteria. Most donors are Caucasian, but Asians and Afro-Caribbeans are over three times more likely to need organs. The incidence of renal failure and diabetes among Asians is six times above the national average, while Afro-Caribbeans are more likely to suffer from kidney-straining hypertension.

So what can be done?

The British Medical Association is now proposing that doctors, unless instructed otherwise, should be automatically entitled to make use of our organs when we die. So instead of "opting in" to the system by registering as a donor, it will be your responsibility to "opt out" if you don't want your corpse used as a medical resource. This is the sort of reform that has occurred in Belgium, Spain, France and Italy. Proponents of the change point out that in Belgium, where only two per cent of the population have chosen to opt out, the number of organs available for transplant has doubled. In Spain it has increased fourfold. But there is no clear evidence that the "opt out" system works. Italy's donation and transplantation rates are lower than the UK's.


Discussion Point - Should people have to "opt out" of organ donation?

YES

  1. "Presumed consent" would dramatically increase the amount of organs available for transplant. Every year, thousands of lives would be saved and hundreds of disabled people given the chance to lead a normal life.
  2. Once dead, our bodies are of absolutely no use whatsoever. Why not presume that people would like their bodies to be used for the greatest possible good?
  3. The law already states that neither the donor's permission, nor his family's, is required. The British Medical Association's proposal would simply underwrite in practice what is already legally permissible.

NO

  1. Forcing people to opt out of organ donation effectively means that our bodies become the property of the state. It will also tempt doctors to look upon critically ill patients not as individuals but as a useful resource to be plundered.
  2. Even if more organs were available for donation, the Royal College of Surgeons reports that there aren't enough surgeons in Britain available to perform the operations.
  3. People could easily forget to opt out, leaving bereaved families - who may have religious or ethical objections - no say over the disposal of their relative's body.

 

The above article is reproduced by kind permission of THE WEEK, where it appeared on 17 July, 1999.

For more information about the organ donor system, see our A-Z, and its link to the NHS Web site.


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