Page last updated at 17:06 GMT, Saturday, 12 April 2008 18:06 UK

How the organ donor system works

The decision to deny a mother organs from her dead daughter and instead allocate them to strangers has been defended by the Human Tissue Authority.

Kidney transplant operation
The Human Tissue Authority is looking at how consent rules could be varied

Laura Ashworth, 21, was prepared to become a "living donor" for her mother Rachel Leake, 39, who has kidney failure.

But she died from an asthma attack before the transplant could happen.

As a signatory to the NHS Organ Donor Register, her kidneys and liver were given to three patients on the official UK Transplant waiting list two days after her death.

A key ethical principle of the current "non-directed deceased donation" system is that neither the donor nor their family can choose who receives their organ when they die.

This applies even if an individual had expressed such a wish while alive by starting the process of becoming a living donor.

General rule

Currently all deceased organ donation in the UK is non-directed: organs are allocated according to clinical need and compatibility rather than according to any specific wishes of the donor communicated while they were alive or of their family.

The system also prevents donors stipulating conditions for recipients - such as race, religion, gender or colour.

The HTA says it is aware of several cases which might merit consideration as exceptions to that general rule.

The HTA recognises there are situations were it may be possible to vary the normal rule of meeting clinical urgent need
Adrian McNeil
Human Tissue Authority

It is reviewing whether "directed" donations should be allowed in exceptional instances and hopes to report back this summer.

Spokesman Shaun Griffin said: "The HTA is very concerned to understand the moral and ethical implications of making such a change.

"We do not want it to become the thin end of the wedge. For example if someone only wants to donate to a person of the same religion - where do you draw the line?"

He stressed the HTA's current position on non-directed donation was backed by the Department of Health and relevant professional bodies.

Good Samaritan

The number of organ transplants in the UK from living donors has been increasing in recent years.

They are all approved by the HTA through an independent assessment process.

Previously donations from the living were only allowed between relatives or people with a close emotional relationship.

But the HTA changed the rules to allow strangers to donate organs to each other under a "paired-exchange" system of matching willing living donors to compatible recipients.

This is where a donor and recipient whose blood groups or tissue types are mismatched or incompatible pair with another donor and recipient in the same situation.

The HTA has also approved several "Good Samaritan" or non-directed altruistic transplants from living donors - where an individual chooses to donate an organ to a stranger.

Clinical need

HTA chief executive Adrian McNeil told the BBC it was looking at different forms of consent to see if the principles can be varied in some circumstances.

"The HTA recognises there are situations were it may be possible to vary the normal rule of meeting clinical urgent need," he added.

"But it is also very anxious not to say yes to certain cases without fully considering the implications more widely should they agree to a change."

The HTA has approved almost 900 living donor transplants, mainly involving kidneys, since 2006.

But there are still more than 8,000 people waiting for organ transplants in the UK - a figure which rises by about 8% a year. And one person dies every day because of a lack of organs.

The government has proposed switching to a system of "presumed consent" for donation after death - meaning everyone would be regarded as a potential donor unless they had specifically opted out.

A taskforce has been set up to consider the issue which is due to report back in the summer.

Mother denied daughter's organs
12 Apr 08 |  Bradford
Kidney hope for 'down under' twin
14 Mar 08 |  Bristol/Somerset
Backing for organ donor overhaul
16 Jan 08 |  UK Politics

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