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Wednesday, July 7, 1999 Published at 11:32 GMT 12:32 UK


The ethics of transplantation

Transplantations are regulated by the UKTSSA

The BBC's Newsnight has revealed the case of a family of an organ donor who requested that the organs only be used for white people. BBC News Online looks at the issues behind the controversy.

Who regulates organ transplants?

The UK Transplant Support Service Authority (UKTSSA) coordinates and regulates organ donation in the UK.

It was reportedly approached by the donor's family in the Northern General Hospital case and told a kidney would be available for transplant, but only if it would not go to a "coloured" person.

According to BBC Two's Newsnight programme, once the organ donation was made, the authority sent out a memo saying "this organ is not allowed to go to anyone who is not white".

The UKTSSA provides a 24-hour support service to all Transplant Units in the UK and Republic of Ireland for matching and allocation of organs for transplantation.

It maintains a database of patients waiting for an organ transplant. It also manages the Department of Health strictly confidential National Organ Donor Register and associated enquiries.

The authority provides a focal point for information on transplantation matters and is available as an enquiry service for health professionals, the media and general public.

Are there guidelines on whether people should be able to stipulate who their organs go to?

The British Transplantation Society drew up guidelines on standards for organ donation last year.

These state that "in general, society does not extend to donors the right to say to whom their should organs should go".

The society is against any form of discrimination and says doctors should be free to decide who receives an organ on the basis of who has the best match.

The guidelines, however, do not have legal force.

Are there any legal bars on such stipulations?

Race discrimination lawyers say they believe stipulating that only white people can receive a donated organ may contravene race relations legislation.

Makbool Javaid, a member of the Home Secretary's race relations forum, says hospitals who use organs on this basis may be liable for prosecution.

Who has a right to give consent over organ donation?

If the person has formally registered as an organ donor or are on an organ register, their views should take precedence, but there has been recent argument about whether a close relative can overrule that decision.

If the donor is still alive, but not able to make a decision, the parents or close relatives should be consulted on whether they think the person would have wished to donate their organs.

Decisions are usually taken after detailed discussions between the potential donor or their family, the UKTSSA and the hospital's transplant coordinator.

Legally, once the person has died, their body is the property of the hospital, but most hospitals prefer to consult the family.

However, the experience is often very difficult, both for the family and medical staff since it takes place at a highly traumatic time.

Organ donor organisations say the family often refuses a request for organ donation because they are too emotionally involved.

The British Kidney Patient Association says polls show that up to 70% of British adults say they are willing for their organs to be donated, but very few actually get around to signing up for a donor card.

Are there any racial barriers to transplantation?

The British Transplantation Society says organ transplants can cross barriers of ethnicity.

However, people from ethnic minorities are more likely to have a successful transplant if they receive an organ from someone from a similar background.

This is because their tissue type matches better so the organ is less likely to be rejected.

Decisions to transplant an organ are based on whether they are in the best interests of the patient.

Therefore the likelihood of an organ being rejected is taken into account.

For kidney transplants, tissue type can be matched because the kidneys can last longer outside the body than other organs.

But in the case of hearts or livers, there is no time and transplant coordinators have to act on information about the organ size and the blood group of the donor and patient.

Transplant experts say people from ethnic minorities have to wait longer for suitable organs to be donated because of a shortage of donors from their communities.

In addition, it is known that people of Asian origin are more susceptible to renal failure than the general population.

For this reason, the government launched a campaign in February to get more ethnic minorities to donate their organs.

It is also trying to highlight the general problem of organ shortage.

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