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We must enable patients to buy live kidneys

By Mike Broad - 4th August 2011 4:54 pm

People should be able purchase live kidneys in the UK for transplant, an academic writing on bmj.com claims.

Sue Rabbitt Roff, a senior research fellow at Dundee University, advocates a system where the standards of pre- and post-operative care would be as good as they are now for kidney donors in the UK, and where the standard payment would be equivalent to the average annual income of around £28,000.

This “would be an incentive across most income levels for those who wanted to do a kind deed and make enough money to, for instance, pay off university loans,” she says.

With three people on the kidney transplant list dying in the UK every day and thousands more attending dialysis units, Roff says there needs to a public debate on “regulated paid provision” for live kidneys.

She explains that a regulated system would not resemble the illegal market that currently exists in several countries where poor people are exploited.

With the number of people with diabetes and high blood pressure on the rise, the demand for kidney transplantation is set to increase, says Roff. However, she adds that “the level of donation of both deceased and living kidneys has never kept pace with the need, and has plateaued at around 2,000 a year in the UK”.

Dr Tony Calland, chairman of the BMA’s medical ethics committee, said the association would not support payment for donating organs.

“We believe that one of the best ways to increase organ donation is to move to a system of presumed consent with safeguards - this would have to be supported by the public and be preceded by a high profile public awareness campaign.

“Organ donation should be altruistic and based on clinical need. Living kidney donation carries a small but significant health risk. Introducing payment could lead to donors feeling compelled to take these risks, contrary to their better judgement, because of their financial situation.”

Roff, however, concludes: “We need to extend our thinking beyond opt in and opt out to looking at how we can make it possible for those who wish to do so can express their autonomy in the same way as current donors are encouraged to do by making available a healthy kidney for a fee that is not exploitative.”

Read the full opinion article.

Tags: Transplants
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Time for presumed consent on organ donation

By Mike Broad - 28th June 2011 2:42 pm

Doctors reaffirmed their support for the introduction of a system of presumed consent for organ donation at the BMA’s annual representatives meeting.

Under presumed consent, also known as an opt-out system, all people are assumed to be willing to donate their organs unless they have opted out. The BMA reaffirmed its support by defeating a motion which called for the reconsideration of its policy.

Those in favour believe it would help boost UK donation rates, which, despite recent improvements, still lag behind many other countries.

Over the last three years, the NHS has invested in specialist nurses and transplant co-ordinators to identify potential donors and allow for approaches to families when death becomes likely.

The BMA supports the introduction of a ‘soft’ system of presumed consent in which relatives’ views are also taken into account. Instead of being asked to consent to donation, they would be informed that their relative had not opted out of donation and unless they object - either because they are aware of an unregistered objection by the individual or because it would cause major distress to close relatives - the donation would proceed.

Donation would be the default position.

More than 3,700 donations took place last year - a 5% rise on the previous year - but there are still about 8,000 people on the waiting list.

Recent figures published by the Scottish government report that the number of Scots on the organ donor register is at an all time high, with 1.8million signed up to save a life. However, last year, there were only 67 organ donors in Scotland, while more than 600 people are still waiting for an organ.

Many more die before they even reach the waiting list.

Dr Sue Robertson, a renal physician and member of the BMA’s Scottish council, said: “Every year people die whilst waiting for a donor organ and evidence from other countries has shown that a system of presumed consent can address the shortage of donor organs and can save lives.

“It is important that an individual’s views on organ donation are taken into account following their death. Repeated surveys indicate that up to 90% of people are in favour of donating organs after their death, yet organ donation rates remain disappointingly low.

“Following the implementation of the recommendations of the organ donation taskforce in 2008, the NHS introduced a more robust system to support organ donation, but now is time for the government to take the next step. A system of presumed consent will create a system whereby the wishes of the individual can be taken into account and will increase the number of organs available for transplant.”

No part of the UK has introduced a system of presumed consent yet, although Wales has said it intends to.

Tags: Organ donation, Transplants
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“Fewer heart transplant units needed”

By Mike Broad - 7th May 2011 9:16 am

The government needs to reduce the number of heart transplant units because too few transplants are being performed and it is difficult for surgeons to maintain their expertise, experts say.

Consultant cardiologist Dr Guy MacGowan, from the Freeman Hospital, Newcastle upon Tyne, says that, despite a record high number of UK donors available for organ transplants generally, there has been a 46% reduction in heart transplantation rates over the past 10 years.

One consequence of this decline is the need for more left ventricular assist devices (mechanical pumps) as an alternative treatment for end-stage heart failure, say the authors.

These devices can be used to support a patient until a suitable heart becomes available or as ‘destination therapy’ where the patient is not considered a suitable candidate for transplantation and receives long term support with the device.

“Newer generation devices have survival rates comparable to transplant at one to two years, so could be considered as an alternative in some situations,” MacGowan says.

Another consequence of the reduced availability of heart transplants is that it is vital to prioritise patients according to who will probably benefit most. It is also going to be difficult for surgeons in the six UK units to maintain their expertise, so the number of units may need to be reduced. This has been recently recognised, and the Department of Health is planning to conduct a review of cardiothoracic transplantation in the UK, say the authors in the BMJ.

The trend appears particular to the UK, with international data show rates are steady or only marginally declining in Europe and the US.

The authors argue that the government review “must recognise that the use of long term devices for destination therapy is an essential service that needs to be developed in transplant centres as a consequence of the falling heart transplant numbers, and there needs to be adequate provision of heart transplantation for adults with congenital heart disease and heart failure.”

Read the full article.

Tags: Cardiothoracic, Reconfiguration, Service design, Transplants
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Inequality in access to renal transplantation

BMJ - 21st July 2010 9:00 am

Significant variation in access to renal transplantation exists between centres within the UK that cannot be explained by differences in case mix.

Researchers from Bristol found that recipients’ age, ethnicity, and primary renal diagnosis were associated with the likelihood of accessing the waiting list or receiving a transplant.

However, after adjustment for case mix, significant inter-centre variability existed in access to the transplant list, in the time taken to register patients on the waiting list, in receipt of a renal transplant from a donor after brain stem death, and in receipt of a renal transplant from a living donor or a donor after cardiac death.

Jump in people joining organ donation register

By Mike Broad - 8th October 2009 7:43 am

Almost a million more people have registered to become organ donors in the last year.

A government report shows that there has been a 7% rise in people signing on to the organ donation register which now has 16.3m names on it. However, the rise is still not keeping up with the demand from patients who need them.

There was an 11% increase in people donating after death and a 12% rise in living organ donors, which provided 172 and 104 extra transplants respectively.

A total of 3,516 people received a life-changing organ transplant in 2008/9. But only about a third of potential donors actually donate, with relatives’ refusal being an issue. Improved road safety has also had an impact on the number of actual donors.

The report covers the progress made in the first year of a new donation structure which has seen the appointment of an extra 100 donor transplant coordinators and 133 clinical leads in hospitals.

But doctors’ representatives have questioned whether the new system - under the guidance of the Organ Donation Taskforce Implementation Programme - goes far enough.

Dr Tony Calland, chairman of the BMA’s medical ethics committee, welcomed the progress but warned that there was still much to do.

“We cannot be complacent,” he said. “We very much hope the 50% increase in donation rates, predicted by the Organ Donation Taskforce, will be achieved in the next five years. But there will still be a shortage of donors and people will still be dying waiting for an organ. Now is the time to have a serious debate about changing to a system of presumed consent for organ donation.

“In our view having a well organised and funded infrastructure, combined with a system of presumed consent, is still the best way forward.”

A further 60 clinical leads in hospitals are due to be recruited.

Chris Rudge, national clinical director for transplantation, said: “These excellent results are due to a new organisational structure that provides a more joined up way of working with in the NHS and making organ donation usual, rather than unusual across the health service.

“We expect to have all the extra NHS staff recruited and in place by March 2010 so that the full impact of the new system will drive organ donor numbers up even further.”

Health secretary Andy Burnham said £16.5m was invested to implement the taskforce’s recommendations, with a further £26.5m earmarked for 2009/10.

“We will continue to support the NHS so that we can achieve our aim to save an extra 1,400 lives each year through the amazing gift of organ donation. We are aiming to get 20 million people on the organ donation register in 2010, working towards 25 million by 2013,” he said.

Read more on one consultant’s decision to altruistically donate a kidney.

Tags: Donors, Transplants
Posted in Hospital Dr News | 1 Comment »

Support altruistic kidney donation - I am

By Graham Potter - 7th October 2009 6:09 pm

In a recent blog, consultant spinal surgeon Paul Thorpe claimed that altruistic kidney donation is a bad idea. Well, I disagree and I’m going to do it.

We don’t “definitely” require the second kidney. We may require it in the future, but there is no “definite” about it. The Human Tissue Authority would not allow the donation if that were the case. Many people are born with only one kidney - mainly men I may add. Yet I doubt very much they all develop kidney disease in that remaining kidney.

Why is donating to a known person any different to donating to a stranger? Emotionally there is a tie with someone you know but I am sure at times there is also undue pressure for the relative to give up a kidney. They may have reservations but be unwilling to deny the person the chance of a better life.

Just because we don’t know the name of the recipient, and we have never met them, does it mean their life is worth less than someone we do know? Not in my book it doesn’t.

Also, I do not think that I should delay donating one of my own kidneys to a stranger just in case when I am 80-years-old a 50-year-old relative may want my kidney - which by then probably does not have much life left in it anyway!

By donating a kidney to a stranger, am I depriving a member of my family from a better life should they ever develop kidney problems that required a transplant?

No. They most definitely are against me hanging around ‘just in case’. In fact they are 110% behind me in wanting to donate to a stranger. There are plenty of other family members around who, should the need arise, can offer one of their kidneys to a relation.

Paul Thorpe seems to be under the impression that middle aged and older people are going to get kidney problems and their renal function will pack up.

I would like to see the medical evidence of this. I am sure the HTA would immediately suspend all live donors over the age of 50 years. Should my remaining kidney develop problems as I get older, then I am more than willing to go onto dialysis like thousands of people do now, especially as now home dialysis is available to all who want it.

I am in very good health. I live a healthy lifestyle there is no reason why my remaining kidney should pack up and require a transplant. But it is a risk that I and many others are willing to take.

Dr Paul Vandenbosch - an altruistic kidney donor - felt any risks involved were minimal. Having worked in the renal unit and treated many kidney patients over the years I tend to trust his knowledge and judgement on this subject, as I do the Renal Transplant Team that I am under.

The cost benefit of kidney transplantation compared to dialysis over a period of ten years (the median transplant survival time) is £241,000 or £24,100 per year for each year that the patient has a functioning transplanted kidney. In 2007-08, 2,282 people received a kidney transplant. These transplants are now saving the NHS £46.1m in dialysis costs each year for every year that the kidney functions.

I totally agree there should be a much more aggressive policy towards increasing the number of donors after death. An opt-out in my opinion gets the thumbs up. It would reduce the kidney transplant list down to zero.

Then, of course, there are the other organs that can be used for transplants as well. There would be no need perhaps for living donors at all. Monies saved through current live donors - altruistic or otherwise - can be put towards a really good long term campaign for organ donors.

As to whether we altruistic donors are brave or stupid, I would say we are neither. It is the recipient who is brave along with their family. Being under dialysis for years is no picnic. Some people have been on dialysis for 20 years or more with no hope of a transplant. Those are the brave people.

I am sure if more people knew what being on dialysis was like and how that and the strict diet and fluid intake imposed on them affects them, more people would want to help.

Am I stupid, as Paul Thorpe suggests? No not at all. This is often an adjective used by people who do not have all the facts and cannot begin to comprehend why some people would want to help others by taking a very small risk in donating an organ. We are also called stupid by people who wish they could donate but just don’t have the will to do so, and it makes them feel somewhat ‘inadequate’. It makes them better to think of us as stupid.

It is strange how some people are hailed great heroes because they climb freezing snow capped mountains, risking losing their nose and fingers and toes and even limbs to frostbite. They also risk death and some have died. But they knowingly take those risks - to what end? Who do they help by making such a heroic journey?

Surely, if taking a small risk to save someone’s life by donating an organ is stupid, then the great explorers who risk life and limb must be insane. No of course they are not, they are heroes. They are heroes because people can relate to them. They admire the courage and determination of the men and women who risk their lives to climb great heights. They understand and appreciate how hard it is to do this - the sheer guts and determination involved.

People risk their lives every day when they get into their cars to drive to work, or to the shops - yet it is a risk we are all prepared to take - for what? To make life easier for ourselves.

We are not called stupid for knowingly risking our lives every day in our vehicles. Yet people are killed, injured, left paralysed from motor accidents. The chances of getting hurt in an accident are far greater than any major problem resulting from donating a kidney.

Why is it so hard for people to accept that some people just want to help others and to them, the risk involved by giving up an organ is far less of a risk than every day life thrusts at them?

Tags: Organ donation, Transplants
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International trade in transplants to be banned

BBC Health - 31st July 2009 9:01 am

The government says it will ban all private transplants of organs from dead donors in the UK.

The move comes after media reports of overseas patients paying to receive organs donated by British people.

An independent report said the public needed to be confident that scarce donor organs were allocated fairly within the NHS. Transplant surgeons said the ban would reassure the public that organs will go to those in greatest need.

Elisabeth Buggins, former chairwoman of the Organ Donation Taskforce, carried out an inquiry after allegations in a number of newspapers that organs from NHS donors were being given to patients from countries such as Greece and Italy.