A transplant director

What is the main role of UK Transplant?

UK Transplant does a number of things in the United Kingdom to do with the organisation of transplants, but it doesn’t have anything to do with individual transplant units. We don’t employ transplant surgeons or pay them, but we keep the list of everybody in the country who is waiting for a transplant; coordinate the way organs are donated after death; and allocate the organs after they’ve been donated to the most appropriate patient. We were given the responsibility of promoting organ donation in the country with long term campaigns, and one of the main areas of concern is to promote donation among ethnic minorities. Patients from ethnic minorities are three to four times more likely to have renal failure and need a transplant, but they’re almost twice as likely to refuse consent for donation if a family member is dying.

Do the big religions support organ donation?

They do. UK Transplant has worked with leaders of the UK’s six biggest faiths to produce leaflets that are available for the families of possible organ donors, explaining the beliefs of that religion.

How long do patients have to wait for a kidney transplant?

It varies according to the patient’s blood group, where they live, and other things. On average, the wait for a kidney transplant is two and a half years. The number of people waiting is going up rapidly—currently more than 6500.

What was the recent first paired kidney transplant?

A lot of people who need a kidney transplant know a suitable living donor, such as their spouse, a family member, or a close friend, but the transplant may not be possible because, for example, their blood groups don’t match. In September 2006 the law changed so that now it is lawful if you find another couple who need a transplant and are also willing to donate, you can give them a kidney in exchange for them giving you a suitable one back. UK Transplant developed a national scheme to identify pairs who could swap; initially take-up was slow, and both clinicians and patients had concerns. Now, every three months we run a computer check to see if any pairs have been identified as potential matches, and earlier this year UK Transplant matched a pair from Cambridge with another couple from Scotland. Subsequently the first paired transplant took place on 4 July 2007. We have more than 40 couples registered.

What ethical questions does the programme raise?

There was a lot of ethical and legal thought about it, the main issue is to ensure that the person doing this genuinely wanted to be a donor and was not being bribed or forced. The system has checks but donors could choose not to tell the truth. Potential donors need to understand what they are letting themselves in for because being a living donor is a huge undertaking.

Nine in 10 people support the organ donation programme, but only one in four have registered. How can this be improved?

It’s largely to do with apathy. Most people support organ donation in principle, but registering means you have to do something. There are a million and one ways of doing it. It could be online, by phone, on paper, when you get a driving licence, or when you change your general practitioner. But it requires effort.

What do you think of an opt-out scheme, in which people have to sign out of being a possible donor?

The secretary of state has sent a task force to consider this and come to a clearer conclusion about whether it will make a difference. I am certain that opting out is not the only solution to the problem, but it might help.

What is the problem with rewarding people for donating organs?

It is a good idea in abstract. But I am convinced that in the United Kingdom it is utterly the wrong thing to do. If you talk to patients who are waiting for a transplant most of them want to know that whoever donated the organ did so because they wanted to. Even if that means they wait. Patients who have had a transplant really don’t like the idea that donation is anything other than altruistic. I think that is right.

Do you have any advice for medical students?

I think that the future lies in all of us knowing more about organ donation. It hasn’t been part of the undergraduate curriculum or the specialties curriculum, but everyone working in a general hospital can encourage patients to put their name on the register. There may be only one person who signs up, but that’s still one donor. Would you have a transplant if you needed it? And, if you would, I think you have a bit of an obligation.

   

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