British doctors endorse radical solutions to organ shortage

Some of the most controversial methods of obtaining organs have been endorsed by the British Medical Association in a report released this week. “Building on Progress: what next for organ donation policy in the UK?” laments “the fact that… people are still dying unnecessarily because of a lack of organs”.

Among the measures it proposes are:

  • Elective ventilation: keeping patients alive solely so they can become organ donors,
  • Retrieving hearts from newborn disabled babies,
  • Using body parts from high-risk donors including the elderly, people with cancer, drug users and people with high-risk sexual behaviour.
  • making donation after cardiac death a normal source for organs
  • a presumed consent system for organ donation.
  • a shame campaign to draw attention to the “moral disparity” of people who decline to donate, but are happy to accept an organ.
  • payment of funeral expenses for donors

All of these measures have been debated extensively over the past few years.

The procedure which the media focused on in its coverage was “elective ventilation”. “Brain dead” patients who have suffered a massive stroke would be kept alive purely to enable organ retrieval. This led to a 50% increase in organ retrieval in 1988 at a British hospital, but it was declared unlawful in 1994.

Transplant units in Spain and the US already use the technique, said Nigel Heaton, professor of transplant surgery at King's College hospital, London. "People have qualms about it. The concern is that you are prolonging or introducing futile treatment that has no benefit for the patient. But I expect that views will gradually change.”

Elective ventilation was criticised by Professor Nadey Hakim, of Hammersmith Hospital, as "bizarre and unethical". "It's not ethical keeping someone alive," he said. "They're brain dead and you have to remember there's a family next door in tears. I find it bizarre that the BMA wants to push for something so unpopular. This is how we kill any desire for people to become donors."

Retrieving hearts from newborn babies is still an experimental procedure. Life support would be withdrawn from disabled children and their heart would be removed about 75 seconds after it stopped beating. Although the BMA report does not mention it, this clearly violates the "dead donor" rule – that donors have to be dead before vital organs can be removed.

The report acknowledges that donation after cardiac death is a hard sell to the public, especially if a heart which stops beating in one body begins to beat again in another. However, the BMA believes that it is ethically acceptable, even though:

“A careful explanation of the way in which death is diagnosed will be needed and an explanation that a heart that has stopped beating can be restarted after the person has died and used for transplantation. It might also be helpful to refer to fact that the first heart transplant, under Christian Barnard, was from a DCD donor.”

Guardian, Feb 13

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