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Transplantation issues

Within the period of April 2009 - March 2010, over 3709 transplants was carried out, with over 7800 people still waiting on the transplant list.

Everyone who is considered legally competent can donate. Entry into the register provides the legal consent for donation.

• Brain stem dead and maintained on a ventilator
• No blood borne viruses (hepatitis or HIV)
• No history of malignancy
• No systemic infections

The criteria for organ donation are distinct from those regarding blood donation. This means that even if you can't give blood, you may still be able to donate your organs.

The heart, lungs, liver, pancreas, kidneys and small bowel can all be transplanted. In addition, many tissues such as corneas, skin and bones can be donated - these are solely taken from living donors.

If the brain stem is damaged, the centres that control breathing and circulation fail and the patient could die. This is the point at which mechanical life support should be discontinued and retrieval of organs for transplant considered. A decision might be made as to the whether the corpse should be maintained on the ventilator until the organs may be harvested.

BSD is diagnosed by 2 doctors (registered for at least 2 years, competent in their field, not members of the transplant team, at least 1 is a consultant) on two different occasions.

Legal time of death = when first test indicate BSD
Death is pronounced at the second set of tests

• Absent brain stem reflexes (pupillary, corneal, vestibulo-ocular, oculocephalic)
• Absent motor reflexes
• Apnoea with pCO₂ > 6.65kPa (patient does not try to breath once ventilator has been disconnected)

If the patient carries a signed donor card (or on the NHS Organ Donation Register), under the Human Tissue Act 2008 there is no legal requirement to ensure that the relatives do not object (even if the donor was a child).

The relatives views should be taken into grave consideration, and if they are opposed to the process then it may be wise to put their wishes first.

No. Neither the donor nor relatives can impose any conditions on the use of the organs.

If the patient is a registered donor, relatives do not have a legal right to overrule their wishes. Consequently, they will discuss the matter sensitively with the medical staff, and encouraged to accept the donor's wishes.

If the wishes of the patient are not known, then under the Human Tissue Act the person who owns the body can authorize the removal of organs. This is usually the next of kin or the executor of the will.

Authorization can be given only after it is clearly established that:

• The deceased has no objections to being used as an organ donor
• The relatives do not object
• There are no religious considerations

Say in the case of a patient who requires a kidney from his twin to survive. There is nothing the doctor (or the court of law) can do to force a person to donate an organ/tissue if they clearly do not choose to do so, even if the recipient will die without the transplant. The Human Tissue Act 2004 specifically requires actual consent in all cases.

No. Under the Human Organ Transplants Act 2004 (This Act superseded the Human Organ Transplants Act 1989), it is a criminal offence to make or receive payment for supplying an organ from a living or dead person.

However payment does not include reasonable expenses (costs of removing, transporting, loss of earnings) paid to a living donor.

(C) Copyright Ministry of Ethics 2010-2014

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