Organ Transplants Presentation

1. Organ Transplants Presentation By Ollie Smith, Tom Moody, Martin Wright and Sam Peat

2. The British System • In the UK the number of people needing transplants is far greater than the number of organs available. • To ensure fair allocations a system is in place, run by NHS Blood and Transplant organisation. • All patients waiting for transplants are added to the UK National Transplant Database. • Allocations are based upon patients’ needs and the importance of the transplant. • Blood group, age and size taken into account of both recipient and donor. • Currently an ‘opt-in’ system is in place, people must register to be a donor. • Doctors will ask families of deceased patients if they mind the organs being used. • But no-one is under an obligation to donate organs.

3. Problems with our System: System has a very low number of donors per million people, 12 per million. Population unengaged with the organ donor process. Not considered as a real problem. Only 26% of population on organ donor register. Units or Organs are sometimes not located efficiently. Large number of deaths while waiting for transplants, 1000 last year. When an approach is made about donation, 40% of relatives often refuse consent. Trust issue, organs are in high demand therefore many terminally ill people have been presumed dead to harvest their organs. Which has raised serious racial and ethical issues. On average one person dies each day on the waiting list due to a lack of organs.

4. The US System • Acceptable organ donors can be as old as 65 years old for many different organs. • Less than half of acceptable donors become donors. • Donor and recipient matches are found using a national computer registry, called the National Organ Procurement and Transplantation Network which is run by the United Network for Organ Sharing. • 58 Organ Procurement Organizations that provide for the 261 transplant centres. • Legal requirement for all hospitals to have ‘Required Referral’ system to alert local OPO who determines whether the organ is acceptable and contacts the family of the deceased. • Signing a donor card indicates a wish to be a donor but there must be consent from family. • 35% of donors never become ones due to family refusal.

5. Benefits: Most organs are allocated on a local scale which reduces time limits and increases the number of successful transplants. Under the National Organ Transplant Act of 1984 there is a Scientific Registry which is the largest in the world where: Public can access hospital specific transplant survival rates and OPO performance rates.

6. The Spanish System • Spanish system is essentially the same as many other western countries, however run by the National Transplant Organisation they have an ‘opt-out’ system which presumes consent. • Doctors generally must still get consent from family members for the organs of donors to be used. • The authorities still monitor waiting lists, organ allocation etc. • But they now have a continuous monitoring scheme that covers the entire system. • About 143 transplant co-ordinators across the country in each hospital are in charge of running the system and upping the donor rate. • There are national and regional offices which act as support for the transplantation programs. • E-mail system and 24hr hotline setup to help improve the donation process and expand training activities. • The budget for transplantation procedures is around €180million and €15million for the procurement network.

7. Advantages: Society has a positive attitude towards organ donation. Donor co-ordinators on every intensive care unit. High donor rate with on average 30.1 per million people. High level of financial input and staff support provided. Low refusal rate of organ donation from families as low as 3%.

8. Improved System: • ‘Opt-out’ system to be put in place which will increase the number of donors available to provide organs. • Recruitment of at least 50 new transplant co-ordinators based in the intensive care units of hospitals • These will be trained centrally rather than by individual trusts. • Ensure education of the public. • Distribute organs locally rather than nationally to reduce waiting times • Dedicated organ retrieval teams available 24hrs a day to collect organs for transplants in the surrounding area. • National Scientific Registry to allow patients to look up the individual success rates of hospitals and transplant organizations. • To change the current attitudes of the public the issue of organ transplants needs to be promoted: • Campaign in schools to educate children of the issues surrounding organ donors etc. • We also are planning a TV-ad campaign that is aimed at the entire country to try and double the number of donors on the register by 2013. • With 10 new donors offering 2 kidneys after death each, in a ten year period the NHS could save around £2.5million.

9. Conclusion • To meet a compromise between the Spanish System and our current system using the ‘opt-out’ title, which improves upon the efficiency and infrastructure of the current scheme and greatly increases the numbers of willing organ donors in the country. • However there are various issues we have to consider: • Public Opinion • Financial implications • Hospital space and resources • Availability of skilled surgeons • The ‘opt-out’ system is likely to increase organ numbers and availability but the NHS should integrate it slowly and meet any public demands. • Clear guidelines should be setup over the consent system and the majority of public support is needed to make the scheme a success. • This system will benefit both individuals and the entire country: • If it is applied with public opinion in mind and an openness to move forward.

10. Thank You For Listening