Kidneys for transplant: More but not all.
Geddes and Rodger (1) provide a useful reminder of the past
inequalities in organ allocation and the huge human cost resulting when
advances in transplantation are limited by a scarcity of available organs.
They do not however address the disparity between those who those who
express a desire to be considered as an organ donor after their death
(over 90% of the UK population in some surveys) and those eligible who go
on to do so.
This reflects the fact that while families of those who make a formal
statement to this effect (approximately 21% of the UK population currently
registered on the National Organ Donor Register) rarely refuse to honour
their relatives wishes regarding organ donation, those not formally
registered face family permission refusal rates of up to 40%. Of the
approximately 1250 potential cadaveric organ donors in the UK in 2004,
surveys suggest that over 1100 would have wished to donate, while in
reality organs were transplanted from only 750 (2).
Increasing public awareness of the National Organ Donor Register as a
means to record preferences on this issue is clearly a worthwhile goal.
Registering just a modest 25% of those who express a desire to donate
organs after death but have not yet placed their names on the national
database would likely result, on average each year, in approximately an
extra 119 donors giving 330 organs including 206 kidneys (2) resulting in
an additional 3500 life years to organ recipients (3) while allowing over
40 million GBP of the NHS budget to be saved from dialysis costs (4).
I recently suggested (5) that the current framing the options for
donor registration in terms of a simple “opt in” or “opt out” dichotomy is
unhelpful. In contrast, a true national census of patients wishes
regarding organ donation would however be an effective strategy for
recording, and therefore respecting, all patients choices about this most
essential of decisions. Surely it is a reasonable public health objective
for the government to consider funding primary care targets for asking
this most important of questions?
Dr. C.S. Hourigan
1. Geddes and Rodger, BMJ, doi:10.1136/bmj.38833.785984.47
(published 27 April 2006)
2. “More Transplants – New Lives. Transplant Activity in the UK 2004
-2005” UK Transplant Statistics and Audit Directorate. August 2005
3. Schnitzler MA et. al. 2005. The life-years saved by a deceased
organ donor. Am J Transplant Sept;5(9):2289
4. Lamping DL et. al., 2000. Clinical outcomes, quality of life,
and costs in the North Thames Dialysis Study of elderly people on
dialysis: a prospective cohort study. Lancet. 2000 Nov 4;356(9241):1543-
5. Hourigan CS. 2005. Registering organ donor preferences - a third
way? Br. J. Gen. Pract. Oct; 55(519):805.
Competing interests: No competing interests