Rates of deceased organ donation in the UK fall well short of those reported from many parts of mainland Europe and North America. This has in part been compensated for by a substantial increase in living donation, and the number of living donors in the UK is higher than that in many other countries. However, our primary focus has to be increasing the number of deceased organ donors and the number of organs that are donated and transplanted as a result. The Organ Donation Taskforce said that donation should become a routine – but still special - part of end of life care. The General Medical Council has also defined the roles and responsibilities of medical staff in the UK who are involved in the care of patients who may be potential organ donors (see box for further details). End of life care is complex however, and it is possible for the potential for donation and transplantation to be lost at various key points in the potential donation pathway. It is by focused attention to these areas of clinical practice that the number of donors and transplants will be increased. The Potential Donor Audit reveals some of ways in which the available number of donor organs might be increased, collectively referred to as the six big wins:
- Consent / authorisation
- Confirmation of brain-stem death
- Donation after Circulatory Death
- Donation from the Emergency Department
- Donor identification, assessment and referral
- Donor optimisation
For comparative purposes donation rates are often expressed in terms of the number of donors per million of population. By this measure, rates of deceased donation in the UK are somewhat lower than those in many other developed countries. While addressing the six big wins will do much to improve donation and transplantation in the UK, it will not increase donor numbers to those recorded in countries such as Spain, Portugal and Belgium. It seems likely that fundamental differences in professional and societal approaches to end of life care account for much of the international variation in donor numbers.
Guidance to doctors from the General Medical Council
If a patient is close to death and their views cannot be determined, you should be prepared to explore with those close to them whether they had expressed any views about organ or tissue donation, if donation is likely to be a possibility.
You should follow any national procedures for identifying potential organ donors and, in appropriate cases, for notifying the local transplant coordinator.
There is no single solution to the shortage of deceased donor organs in the United Kingdom. The six big wins describe the areas of clinical practice, as measured by the Potential Donor Audit, where potential donors and the transplants that could result are lost.
- GMC guidance on End of Life Care, 'Treatment and care towards the end of life: good practice in decision making'
- Organs for Transplants: a report from the Organ Donation Taskforce
Comparative statistics on rates of donation and transplantation can be found at the Global Observatory on Donation and Transplantation at www.transplant-observatory.org/pages/home.aspx, and at the Transplant Procurement Management website at www.tpm.org. Next section: Organ Donation Taskforce