Joseph Walsh, 2nd year, looks at the steps that can be made to reduce the time patients in need spend on the transplant list.
In the wake of fresh calls from the BMA and countless patient charities – such as the British Heart Foundation – for there to be reform to the organ donation system in the United Kingdom, it is clear that both the government and NHS need to work together to improve organ donation rates.
Recent data published by the NHS shows that as of April 2012 at least 7,612 patients are waiting on the transplant list; in reality the number of people actually requiring some form of transplant is probably even higher than this. Regrettably around 1,000 patients die each year while waiting for a transplant and, with only around 29% of the total population of the UK being signed up to the Organ Donor Register, clearly there is a lot of progress to be made to ensure that more people receive the transplants they so desperately need.
How exactly to go about improving organ donation rates is by no means a newly debated issue. The argument between the current opt-in organ donation system and those suggesting an opt-out system has been brewing for well over a decade. The UK Government acknowledged the necessity to improve donation rates and set up an independent task force in 2008 to assess the current situation and make recommendations for the future.
The report published by the task force was extensive and, while it did not agree that implementing an opt-out system was the next necessary step, has offered several suggestions. Advice recommended in the report includes improvement in several areas- donor identification and referral, donor coordination, and organ retrieval. Whilst I appreciate that these are all very valid suggestions, I can’t help but think that much more needs to be done than merely looking to improve the healthcare systems that are already in place.
In comparison to other countries around the world, the UK – while not leading the way – is certainly not struggling to pull its weight in terms of organ donation rates. Even Spain, who have implemented a system of opt-out organ donation, perform only slightly better than Britain when the numbers of living and deceased donors are added together. The Spanish government themselves attribute their success, in part, to being able to sell the concept of donation to the general public. Perhaps this suggests that in order for the desired improvements to be achieved, more needs to be done than just implementing an opt-out system.
When questioned, around 70-90% of people say that they support organ donation, according to the BMA, but it is clear that many of these people are not on the donor register. One of the best moves for the NHS and government to make would be to publicise organ donation actively and make signing up a more simple and transparent process. From my own perspective, I signed up because there was an extra box to tick on the application form for my provisional driving license at the age of 17. Had I never signed up for a driving license, I can honestly say that it would have ever occurred to me to join the donor register, and maybe my experience typifies that of many other people.
Providing people with more opportunities to consent to organ donation and so making organ donation something for the majority – and not just the minority – to consider seriously, would mean a much greater proportion of the population is likely to sign up to the organ donation register.
The Welsh government published a draft organ donation bill in June 2012 to bring in a system of presumed consent, dubbed to be a “soft” opt-out option, with the intention for the changes to be in place by 2015. Under the new proposals everyone in the population would be eligible to have their organs donated, unless they choose to opt out from the system themselves or, if at the time of death, family members choose not to allow the organs to be donated. It will be interesting to the impact of this ‘soft’ opt-out option on the organ donation rates in Wales, especially keeping in mind the potential for a similar system to be implemented UK-wide.
As I’ve alluded to in this article it is important to remember that rates of organ donation are, of course, only one aspect of the problem. The NHS needs to take a variety of approaches to help bring down the transplant waiting list times. However, helping to change the culture and attitudes towards organ donation in the UK will be the most vital aspect to tackle in order for significant improvements to be made to the situation as it stands.
Prioritising the problem of organ donation would result in a great improvement to healthcare nationwide. If we keep reminding ourselves of the positive impact it will have on those who are sat waiting for a transplant, I see no reason why the UK cannot help lead the way in this increasingly important area of medicine.
1. Organ donation statistics [Online] Available at: <http://www.organdonation.nhs.uk/ukt/statistics/downloads/weekly_stats.pdf> [Accessed 30th October 2012]
2. Organ donation register [Online] Available at: http://www.organdonation.nhs.uk/%5BAccessed 30th October 2012]
3. Public opinion on organ donation [Online] Available at: http:// www.bma.org.uk/images/ organdonation_buildingonprogressfebruary2012_tcm41-211719.pdf>%5BAccessed 30th October 2012]
4. (Image) Organ donation card [Online] Available at: < http://www.telegraph.co.uk/comment/telegraph-view/9079415/Nudgedont-shove.html> [Accessed 29thDecember 2012]