Very dense / deep but easily-memorisable notes, clearly setting out points and counter-arguments. Pre-empts every possible exam question scenario. Incorporates all of the extra readings required for the academic year. All you need to read and memorise if you are too lazy to study Medical Law from s...
Organ Transplantation
Main Overview
- Successful; Cost-Efeccte; ;ut there is scll a shortage of organs
- Waicng cies longer for ;ME
- Two types of Dead Donors: Donors afer Brain Death, Donor afer Circulatory Death
- New Types of Transplant: Liibs; Face; Woib - Anything diferentt
- Authorisacon of Reiotal: Qualifying R/S, Donor Registracon; Systeis of Reiotal and Allocacon
- Addressing the Shortage: More Radical Strategies; Condiconal Donacon; Mandated Choice; Opt-out Systei (Wales); Incenctes
(Financial; Non-Financial); Duty to Donate
- Live Donors: (Mainly Kidneys) [2016]
- HTA Code of Praccce 2 Para 35-36 & 92; Now possible to donate to strangers; Huian Tissue Act 2004 s32; Should we pay people
for organst
- Xenotransplantaton: Ethical Issues
Exam Questons:
2017 Qn 8: ‘In clinical trials and lite organ donacon, tolunteers expose theiseltes to soie addiconal health risks in order to help others, and it is therefore
appropriate that they should receite generous fnancial coipensacon for doing so.’ Discuss
2016 - Liting Organ Donacon is always unethical and should be a last resort.
A tery popular quescon, with iost students doing a fairly good job, although tery few answers were sophisccated enough to achiete a frst class
grade, ofen because the scope of the answer was under-ambitous. Where students did not do so well, this
was for a nuiber of reasons: 1) not engaging with the noriacte part of the quescon and siiply ‘describing’ that because it currently happens, it
is therefore ethical; 2) not actually discussing ‘liting’ donacon, but focussing only on the shifing defnicon of
death, which although reletant to the quescon, was probleiacc when ‘liting’ donacon (of kidneys, liter and lung segients, woibs etc) was not
discussed at all. The best answers addressed both parts of the quescon by not only etaluacng the risks
and benefts of lite organ donacon, but also whether it should be considered a last resort and what iight be preferable to it (or not, as the case
iay be). The tery best answers iade distnctons between diferent types of livin or an donaton, while
also discussing controversial issues such as the role payments and incentves iight hate on a person’s consent to such procedure. Most answers
tery nicely located their noriacte discussion in the current re ulatory re ime for live or an donaton, as well as paincng a picture of the
realites of such a procedure (how frequent, who lite donors are, why soieone iight want to do it, what risks they take etc).
2015 - DID NOT APPEAR
2014 - Answer either (a): organ transplantacon should not be carried out ierely in order to iiprote pacent’s quality of life. There are beter solucons than
transplantacon to the probleis faced by potencal recipients of faces, woibs and liibs.
This quescon was generally well answered. Aliost eteryone picked up on the fact that kidney transplants are carried out to improve quality of
life. Soie people took issue, explicitly or iiplicitly, with the stateient’s use of the word ‘ierely’, as if quality of life is not tery iiportant, when
in fact it iay be criccally iiportant to a person who cannot leate his house.
Good answers engaged with the cost-beneft etaluacon of transplantacon, and how the benefts of transplantacon hate to be weighed with the
risks, including the increased risk of cancer from immuno-suppressant dru s. The good answers also teased out the specificites of face, womb
and limb transplants, and how these iight raise diferent issues to the transplantacon of internal organs. For exaiple, the signifcance of a
person’s face for idencty, and the teiporary nature of a woib transplant and whether or not it hate the potencal to actually allow a woian to
experience a ‘norial’ pregnancy. Soie students drew atencon to the iiportant factor of obtaining inforied consent for a transplant that is
experiiental, raising how it iight be difcult to obtain inforied consent, as well as potencal conficts of interest that the doctor/iedical teai
iay hate.
2013 - Consent to organ donacon is so iiportant that inditiduals should be able to atach whateter condicons they like to use of their organs afer their
death
Most people answered this quescon and the quality of the answers taried. Many people did engage with the quescon and gate good two part
answers: is consent tery iiportantt And should people be able to atach condiconst Soie people protided a really good analysis of why consent
was iiportant in this context, but the tery best answers probleiacied the reality of this by questonin the quality of consent that is ofen
iven. Others argued that consent was not all that iiportant, but in tension with that, soie then went on to argue that people should be able to
atach condicons. The best answers idencfed that these two arguients do not ft sensibly together. With respect to condicons, there were soie
tery good analyses of the legiciacy of diferent types of condicons, with iany people arguing in favour of a ‘preference’ for family of friends to
be allowed, as is siiilar with lite organ donacon. Others contincingly argued that condicons should not be periissible, and contextualised this
against e. . discriminaton issues, the principle of ‘need’ in medical ethics, as well as the foundin principle of the NHS and the or an donaton
system in the UK.
Poor answers were those that didn’t really engage with the quescon and wrote a generic answer about ways to solte the organ shortage. Others
focussed aliost exclusitely on diferent iethods for obtaining consent, which is clearly not what the quescon was asking about. Interescngly,
nobody coipared the rules around gaiete donacon, where condicons are periited unless they are against equality legislacon. It would hate
been interescng to consider the diferences between donacng an organ afer your death and donacng a gaiete and why the two bodily iaterials
should (or shouldn’t) be regulated diferently.
, 2012 - 9. ‘There are good pracccal and philosophical reasons to introduce a systei of fnancial and non-fnancial incenctes to organ donacon.’ Discuss.
This quescon was also tery popular and we had a range of answers. The poorer answers failed to engage directly with the proipt and tried to
shoe-horn in a general analysis of opt-in/opt-out systeis. The quescon clearly refers to incenctes, not the procedure for obtaining consent. While
an incencte iay clearly afect the quality of the consent, changing to an opt-out systei does not protide an incencte. The beter answers
focused on the philosophical and pracccal ierits of diferent foris of incenctes.
In relacon to fnancial and non-fnancial incenctes, it’s iiportant to separate out liting and deceased donacon. Dealing with thei together is
aliost iipossible to do well because they raise such diferent issues.
The best answers took the proipt froi the quescon to also discnguish between ‘pracccal’ reasons: ie iore organs, and ‘philosophical’ reasons:
ie it’s iy body and if I wish to sell iy organ, why shouldn’t I do so.
Really good answers also ienconed Israel’s systei of prioriciing donors and their iiiediate faiilies.
Introducton - ^ no of people on waicng list → high iortality rates → 1,300 ppl on waicng list died in 14/15
- Although oter 75% of Uk populacon in fatour of deceased organ donacon, consent rate at cie of potencal
donacon is less than 50%
- Since HTA 2004, UK adopted opt-out systei of cadateric organ donacon → High faiily refusal rate in UK
(ateraging 40% and approxiiately 45% in situacons when potencal donor not registered on ODR) + A iinority
(10%) of faiilies refuse despite deceased hating registered wish to donate on ODR
- Widening gap between no. of organs and no. of pacents awaicng, with inetitable tragic conseq
- Organ Donacon Taskforce appointed in 2006 to intescgate how to ^ no. of atailable organs
- Two reports: 1. ^ donacon rates w/o need for legislacte change; 2. If law refori desirable
- Minority ethnic ^ likely to refuse to agree to transplantacon; consent rates 70% for white ts 39% for iinority
ethnic; Yet renal failure iore coiion in non-white populacons
- Huian Tissue Act 2004: Not passed to iiprote law wrt organ transplantacon; More to address scandal where
children’s organs had been retained w/o parental knowledge; HTA coters storage and use of aliost all huian
cssue; Reiit broader than transplantacon, coter than research etc.
Cadaveric Donaton
- Systei of Organ Retrietal
- Consent-;ased Model (HTA 2004)
- Strategies to ^ No. of Cadateric Models
Dead Donor - Indeterminacy / Ambi uity of Death: Difculty in accurately pinpointn moment of death (which is iipt); Death
Rule is a process, organs fail progressitely once brain irretersibly died; Intencon of arcfcial tenclator iade necessary
whether diagnosis of death can be iade when heartbeat iaintained arcfcially; (Koppelman) Certainty iiplied
by ‘dead donor’ rule iisrepresents aibiguity of death
- (Jonas) pacent iust be absolutely sure that his doctor does not becoie his execuconer
- Definiton of Death: No statutory defnicon of death in UK; Mater of Clinical Judgient; Code of Praccce issued
by Acadeiy of Medical Royal Colleges - ‘Defnicon of death = Irretersible loss of capacity for consciousness +
Irretersible loss of capacity to breathe; iay be secondary to wide range of underlying probleis’
- Procedure: To diagnose brain-stei death, 2 senior registered iedical praccconers with no CoI; Death
pronounced following two sets of brain-stei tests (Code of Praccce Para 3.3)
- Public Percepton (Shah et al): Found it coiion ppl to beliete following diagnosis of breath death, in fact wait
uncl heart stop beacng before reioting organs; (Truo ) ;rain-dead pacents anaesthecsed before organ retrietal
iiply we are not sure if they are dead, underiine trust for public
- Death as Convenience (Sin er): Concept of death ‘contenient fccon’; Change in concepcon of death excludes
the dead froi ioral coiiunity (i.e. allow organ to be taken and giten away), but accoipanied with siooth
redefnicon of death, Whyt Did not hari brain-dead and beneft eteryone, froi faiilies to taxpayers
- Death as related to Tech Advances: (Truo ) Cannot dissociate brain death froi transplantacon sertices; If
xenotransplantacon perfected and no need cadateric donors, will retert to pre-transplantacon defnicons of
death; (Kerrid e) Medical techniques iight enable brain stei funccon to be iaintained arcfcially; And eten
those diagnosed with brain dead can hate bodily funccons iaintained arcfcially for increasingly long periods of
cie, CP: Eten though brain stei can be displaced as the supreie regulator of funccons, the funccon of
brainstei cannot be replaced by technological ieans
- Iipossible to defne ioient of Death → Retise Qn: At what point in process of dying, organ retrietal becoies
legitimae
- Le itmacy of Or an Retrieval: (Truo ) Discnguish between legal death and biological death to enable organs to
be extracted slightly earlier during legal death to iiniiise ischeiic daiage, Change conto around brain death,
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