Transplant coordinators need more money for education

EDITOR,—Celia Wight and Bernard Cohen point out that the fall in the numbers of organ donors due to declining death rates from intracranial haemorrhage and road traffic accidents should be welcomed.1 We would suggest that herein lies the most important limitation on the current transplantation programme. However, organ donation, as well as providing the obvious benefit to potential transplant recipients, can offer a bereaved family considerable comfort. It is the family's bravery and generosity at a time of tragedy that allow this practice to continue. This factor should not be lost in the continuing debate surrounding the perceived shortage of donor organs.

Failure to provide adequate physiological support to potential organ donors accounts for the loss of at least a quarter of donor organs.2 Further education in the management of donors could reduce this figure, so that better use could be made of this scarce resource. We recognise that there are geographical inadequacies in the service of transplant coordinators, but the report of the British Transplantation Society Working Party found that only a quarter of coordinators have a budget for educational purposes and many rely on money from pharmaceutical firms.3 We agree with the report's recommendation that the existing service should be expanded so that all coordinators have the resources with which to carry out this vital function, and we believe that this should be done before investment is made in the commercial ventures suggested by Wight and Cohen.

While we understand our transplant colleagues' desire to find new ways to increase the pool of donors, we urge them to proceed with care in their bid to change the law regarding interventional ventilation. The report of the British Transplantation Society suggests that only 19% of 141 units where interventional ventilation was discussed would support this practice.3 Transplant coordinators have worked for many years to build and secure trust among medical and nursing staff in intensive care units. This trust is based on the knowledge that the life of one person is not more important than the life and process of death of another. Anything that might jeopardise this relationship would be detrimental to current donor referral rates.