Other Areas of Interest

Topics listed here comprise areas where UKDEC is aware of questions arising and has in most cases initiated discussion with the relevant stakeholders. Methods will depend on the topic and may be limited to a committee discussion, or a more public debate, for example in a workshop format. Timing for taking work forward is dependent on a number of factors.

• Allocation of organs: NHSBT is currently revising policies on allocation of organs to be consistent with legal and other requirements. Once that process is complete UKDEC is expecting to be asked to consider the ethical issues arising in allocation
• Paediatric organ donation and transplantation. There are a number of ethical issues specific to organ donation and transplantation in infants and young children, which warrant attention. UKDEC has asked the Academy of Medical Royal Colleges to review the diagnosis of death guidelines for infants between 37 weeks’ gestation and two months of age, which have not been updated since 1991. The UK is currently out of step with most other countries in Europe on North America on this issue. The British Association of Perinatal Medicine has established a working group to consider organ donation from neonates, and UKDEC awaits the outcome of that work with interest. UKDEC is working with clinical teams interested in developing a protocol for cardiac donation from a newborn donor following circulatory death.
• Donation from the Emergency Department: The British Transplantation Society and the College of Emergency Medicine have published the report of a workshop: The Role of Emergency Medicine in Organ Donation. Members of UKDEC were involved in the workshop. The recommendations are in line with the recommendations UKDEC has developed on donation after circulatory death. The report can be accessed via the British Transplantation Society’s website
• Review of the Organ Donation Register. As a result of our consultation exercise on the draft ethical framework for donation after circulatory death, UKDEC is aware of a number of issues connected with the potential of the organ donation register. These include how accurate and comprehensive it is, whether it represents (informed) consent, and whether, if it contained considerably more information, with the potential for changes to be made, this would increase its potential value and usefulness and be of greater benefit both to potential donors and those organising organ donation and transplantation.

Two further issues arose through the development of the Ethical Framework for Donation After Circulatory Death:

• Interventions before death that are of no clinical benefit to the (circulatory death) donor: After life-sustaining treatment has been withdrawn from the donor, but before they have died, interventions may be considered which may increase the likelihood of a successful transplantation, but bring no clinical benefit to the donor (eg administration of heparin). DH published legal guidance on the practice of donation after circulatory death in 2009, which stated that interventions that cause or may risk causing harm or distress would not be in a patient’s best interests, and this included heparinisation, among others. UKDEC considers the analysis of the risk/benefit balance was not sufficiently clear and will be pursuing this issue with the Department of Health
• Withdrawal of life-sustaining treatment. It is known that there is significant variation in practice in the withdrawal of life-sustaining treatment, which in turn can impact on the likelihood of a patient becoming a donor (after circulatory death). UKDEC is working with the relevant professional bodies to facilitate development of appropriate guidelines.