Chamali Fernando was Parliamentary candidate for Cambridge in 2015. She is a barrister, and has written a dissertation focusing on human organs for transplantation.
The NHS estimates that three people die daily in the UK in need of a transplant due to the shortage of willing organ donors. The changing demographics of an ageing population and growing incidences of diabetes mean that the need for kidney transplants will increase, especially within ethnic minority communities, which are particularly vulnerable since the need for kidney transplants is high, yet organ donation is not part of culture or tradition.
To increase organ supply, Britain is exploring novel medical techniques such as perfusion, moving towards a system of presumed consent (as in Wales) and making it easier to honour an individual’s wish to donate an organ after death. Whilst an opt-out system is a step in the right direction, it is not enough. There are additional avenues that could increase organ donation and save more lives.
Currently, organ donors can register online or at the doctor’s surgery or when applying for a licence, a Boots Advantage card, or a European Health Insurance card. Quite simply, opportunities to register could be extended to dental surgeries, opticians, beauty spas and health clinics.
More funding is required for research into procedures designed to improve the suitability of cadaveric organs for transplant.
For effective transplantation, a cadaveric organ must be retrieved as soon after death as possible, but accepting death is a process, and relatives may be hesitant or reluctant to consent to organ retrieval. An opt-out system would fail substantially to increase supply were relatives to retain the right to veto organ retrieval. There should be an opportunity annually for donors, perhaps for example via their GP or at the opticians, to re-affirm their intention to donate their organs after death, so that relatives who are confronted with the loss of a loved one can be re-assured that the patient’s wish to donate remained constant or was recently confirmed.
Research shows that transplanted organs from living donors function better than deceased donor organs. Healthy organs such as kidneys, lower lobes of lungs and liver segments can be sourced from the living under optimal pre-planned conditions. The condition of human organs deteriorates when blood supply to them is interrupted through traumatic events associated with illness, intensive care and death. With living donors, hospitals can also carry out stringent matching and donor evaluation requirements and thereby reduce the risk of organ rejection.
Whilst it is unethical to pay people for organs, donor expenses incurred in the transplantation process could be reimbursed in the same way that UK egg and sperm donors are compensated.
In America, the National Organ Transplant Act (“NOTA”) 1984 made it illegal to knowingly procure, receive or transfer a human organ for “valuable consideration” (payment) for use in transplantation.
Whilst this directly prohibition on payments for organs, Pennsylvania state does pay up to a maximum of $300 USD (approx. £225) towards the food, travel and lodging costs of the donor’s families. The reimbursement goes direct to the organ provider rather than the family. Pennsylvania’s Department of Health refused to allow larger payments of $3,000 to $5,000 to be made towards the funeral expenses of the deceased donor provider because that would violate NOTA’s clear prohibition against “valuable consideration.” Pennsylvania’s scheme operates in both living and deceased human organs. However, if the donor is deceased there is no need for his family to travel and incur costs. Therefore payment is usually only made in respect of living suppliers of organs. Accordingly, a distinction is drawn between payment for the organ and payment for the associated expenses of the donation.
Limiting the reimbursement is sensible and simply removes a cost barrier to altruistic donation. The reimbursement should be small or reflect actual documented expenses (as required by the Declaration of Istanbul on Human Organs which the UK has endorsed). In this way, the reimbursement does not manipulate an individual to donate. In essence, we should be looking to encourage those who have already have an altruistic intention to donate but might be prevented from doing so due to loss of earnings, travel, or other transplant associated expenses.
Recognising the generosity of donors could help motivate altruistic donation. The organ donor register is confidential but, if, after the transplant, donors are willing to disclose their identity, it may benefit society to acknowledge their sacrifice; help spread a feel good factor and possibly encourage other donors to come forward.
Bioethicists such as Julian Savulescu have argued that an altruistic donation system could offer tax breaks to people who contribute their organs. We currently allow tax breaks to people who give money to charity. Tax breaks do not undermine the altruism in giving money to charity, but reward people for contributing to a sector reliant on good will and generosity. Tax breaks for organ donations are slightly more controversial: care must be taken not to place a value on the organ itself but a value on the generosity of the act.
In addition to a system of presumed consent, reimbursing expenses, public recognition of donors, more opportunities to register and more funding into research are all steps that can increase the supply of available organs from both living and deceased donors.