Lecture notes, textbook notes, academic articles and class notes on organ transplantation. From the London School of Economics and Political Science. Emily Jackson textbook and lecture notes. Ideal for medical law exams and essays! In-depth notes to succeed :)
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Week 3:
Organ Transplantation:
Why do we need people to donate organs?
- Organ failure likely to increase due to ageing population, and rise in conditions related to obesity, and alcohol
consumption.
- Big shortage of organs for transplantation!
o 400 people died while on the active list waiting for transplantation -- but many more removed from list due to
ill health.
Donation in BAME communities:
- Higher rates of hypertension, type 2 diabetes, and certain types of hepatitis = greater need for organ transplant.
- Of 1600 deceased donors, 121 were from black Asian and ethnic minority communities.
- 31% of people on the transplant waiting list are from BAME communities.
- Median wait time for an organ:
o White person: 640 days
o Asian person: 830 days
o Other BAME person: 810 days
o Black person: 965 days
Organ transplantation is successful:
- A year after surgery:
o 98% of kidneys in living donor transplants are still functioning well
o 95% of kidneys from cadaveric transplants are still functioning well
o 94% of liver transplant patients are still alive
o 84% of heart transplant patients are still alive
And Cost Effective!
- Average cost of dialysis: £30,800.
- The cost of a kidney transplant is £17,000 per patient per transplant + £5000 per year for immuno-suppression.
- Over a period of 10 years, a kidney transplant saves the NHS £241,000 = £24,100 per patient per year.
Views on Donation:
- Why do people donate?
o Support the system: give and take
o Make something out of a loss
o Altruism
- Sense of community
- Why don’t people donate?
o Fear
o Religion
o Apathy
o ‘Ick-factor’
Types of Organ Donation:
- Post-mortem (i.e. deceased donor)
o 61% of organ donors
o Around 80% of transplants
- Inter vivos (i.e. living donor
o 39% of organ donors
o Around 20% of transplants
Post-Mortem Donations:
- Two types:
1. Brain death
o Irreversible cessation of cerebral and brain stem function; characterized by absence of electrical activity in the
brain, blood flow to the brain, and brain function as determined by clinical assessment of responses
2. Circulatory death
o Death resulting from the irreversible cessation of circulatory and respiratory function.
What organs can be taken?
- On the organ donor register, you can opt for:
o A: any of my organs and tissue.
- Or
o B: tick which of these you wish to donate:
kidneys
heart
liver
small bowel
eyes
lungs
pancreas
, tissue
New Types of Donation:
- Hand
- Limbs
- Face
- Tongue
- Womb
Is there something different about these types of donation?
- Risk-benefit analysis different as it is not life-saving. But:
o Profound effect on quality of life
o Neither are kidney transplants?
- Difficult to anticipate the long-term physiological and psychological consequences?
o Evidence so far = good.
- Issue caused by social attitudes to disability and disfigurement?
Womb Transplants:
- Should they be publicly funded?
- Risks to foetus of taking immunosuppressants while conceiving/ pregnant.
o If the body rejects the womb, would kill the kid
- What if the transplant fails while pregnant death of foetus.
- Womb transplants only intended to be temporary and then removed. [To enable someone to get pregnant]
o Risky- can this be justified?
When can an organ be removed?
- HUMAN TISSUE ACT (2004)
o Section 1 HTA: permits the removal, storage and use of organs for transplantation from a deceased person as
long as there is ‘appropriate consent’.
o S3(6): this [appropriate consent] can be given by:
1. The donor [signing up to the register, or having said something]
2. The donor’s appointed representative
3. The person in the closest ‘qualifying relationship’
Qualifying Relationships:
1. Spouse, civil partner or partner (defined as ‘live as partners in an enduring family relationship’ (s54(9))).
2. Parent or child;
3. Brother or sister;
4. Grandparent or grandchild;
5. Child of a brother or sister;
6. Stepfather or stepmother;
7. Half-brother or half-sister;
8. Friend of long standing.
- If a child, then the parental guardian + child have to consent
- Family’s don’t have a legal veto if they have made their decisions clear [if they have signed up on the donation register]
o But in practice, hospitals are unlikely to continue with the donation if the family are not in agreement/don’t
consent for publicity reasons [would look bad on the entire donation programme if the family didn’t consent.
The Act was passed within the midst of this situation [children were having their organs donated without their
parents’ consent]
Recipients:
- One organ donor can save 8 lives
- Central allocation [by NHS]
o Waiting list based on need and compatibility [best tissue match, or similar ages]
Need to weigh this up between need and compatability.
Reforming the law on organ donation:
- 1. Organ Donation Taskforce (ODT) 2008:
o Recommended improved coordination not a change in the law.
Make donation usual, not unusual.
Removing bureaucracy e.g. having local level operators
Alternative Models:
- Opt-in
- Mandated choice
o Doesn’t mean that you have to do either one, but everyone has to decide.
This ensures that people don’t sign up because of apathy not very interventionist
- Opt-out 22 countries have this.
o Human Transplantation (Wales) Act 2013
Studies show that people would be in favour. Apathetic people will have their organs given.
Question: is tacit consent equal to active consent?
Can we ensure that the public is informed enough to know that they are automatically on this
list?
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