Page last updated at 07:56 GMT, Wednesday, 17 March 2010

'Attitude' is blocking organ donations

Dr Paul Murphy
VIEWPOINT
Dr Paul Murphy
Consultant in neuro-anaesthesia and critical care, Leeds General Infirmary and National clinical lead for Organ Donation, NHS Blood and Transplant

Three people die each day in the UK because a suitable organ can not be found.

Organ transplant box. Pic: Michelle Del Guerico/SPL
Only a few people go on to donate organs

In this week's health opinion column Scrubbing Up, Dr Paul Murphy says doctors and relatives are blocking patients' wishes to donate organs after death. He says attitudes need to change so that more lives can be saved.

I am a specialist in a branch of intensive care medicine that specialises in treating patients who have suffered life-threatening injuries to their brain or spinal cord.


Because of the nature and severity of their illness, around one in six of my patients will die, and in their death many of them have the opportunity to become organ donors.

Around 90% of people in the UK believe in organ donation and would wish to receive a life-saving transplant should they become ill.

However, only a relatively small number of people will ever be able to become organ donors.

For instance, to be able to donate solid organs - your kidneys, liver, lungs, pancreas and heart - you have to die in hospital, and in reality many people die elsewhere.

Yet, even when people die in appropriate circumstances, and when there is no medical reason for them not to donate, not even half of all suitable potential donors go on to donate.

Lost opportunities

And this sad fact means that when they die, several other people's grip on life weakens too.

At least three people in the UK die needlessly every day through lack of a suitable donor organ.

There are many reasons why donations do not happen when they could.

Much attention is given to the rates of family refusal - if 90% of people believe in donation, why do 40% of families say no?

Of course, one major factor is the obvious one: it is one thing to have a view on what happens to you personally when you die, but another thing entirely to be the grieving relative around the bedside who is struggling to come to terms with the sudden, unexpected and untimely death of a son or daughter, soul-mate or parent.

The desire to protect a loved one, to avoid further harm, is both intrinsic and intense.

On other occasions, clinical staff may consider donation inappropriate because it might become necessary to adjust in some small way the care that a patient receives when they die in order to make a donation happen.

For example, to allow time for a specialist surgical team to travel to the hospital where a potential donor is.

Clinical staff who offer the option of donation to grieving families do so not because they are hand in glove with transplantation, but rather because they recognise the heroic gift that donation is

They too have a basic protective reflex - to avoid any potential for conflict, the potential of being accused of caring more about the needs of transplant recipients than those of the patients they have been unable to save.

Both positions are understandable.

But both are slightly off the mark, because they fail to put the needs and the wishes of the deceased person first, at the centre of decision-making.

Gift of life

Clinical staff who offer the option of donation to grieving families do so not because they are hand in glove with transplantation, but rather because they recognise the heroic gift that donation is, the chance for you to fulfil a desire to be a saviour to people who will never meet you, but who will never forget you and the gift of life that you gave them.

Clinical staff who offer donation, sometimes in the most unimaginably difficult circumstances, do so because they consider donation to be part of the care that should be given to people when they die, the posthumous fulfilment of an altruistic and noble decision.

I have sat around the bedside of a dying man with his family, and watched a sobbing father kiss his son's forehead as he left the ICU for the operating theatre.

If there were ever any doubts over the lawfulness of such an approach, recent guidance issued by the Department of Health indicates that the law is on their side.

And this is where the advocates of presumed consent have also, perhaps, missed the crucial point, because donation is about donors as well as recipients.

I have sat around the bedside of a dying man with his family, and watched a sobbing father kiss his son's forehead as he left the ICU for the operating theatre.

It is hard to see how the failure to register a wish not to donate has any resonance whatsoever with occasions such as this - where the focus is on a supreme act of giving, not on a double negative.

Donation is a personal choice, and no one would criticize a family for saying no.

But I have witnessed the positive effect that donation has for a bereaved family so many times, and I cannot help wondering whether we always present it to families in the right way - as something that we do for patients rather than to them.

And present it at the right time, when they are in a position to see it as something that is part of end of life care, rather than something that is inflicted upon them when they have yet to accept their loss.

Clinical staff need to be more sensitive about when is the right time to ask a family, but perhaps we all have a responsibility to make it easy for our families - by getting onto the NHS Organ Donor Register and by telling them that we have done so.




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