Skip to content

Living Organ Donation - Lecture Notes 24/1/2020

Kirsty Moreton

The question at the base of this: how should we procure organs in E&W whilst keeping within cultural, ethical and legal boundaries

What things come up here?

  • Cultural beliefs about giving or receiving body parts
  • The donor was perfectly healthy, and we are doing something that could be seen as harm to them
  • Issues of altruism - Family Links
  • Bodily integrity (especially of the donor)
  • Commercialisation

The Background

This is coming from the alder hey childrens scandal (1988-96). Children who had died had tissues/organs retained without the knowledge of the parents.

No consent gain, no knowledge of the action.

There was a review by the CMO at the time, published in 2001.

There was a commission by the government. The RC Path put out guidelines emphasising the importance of consent for this.

Living Organ Donation - performed for first time in 1950's

There are different types of living organ donation in the UK:

  • Directed Donation - where the organ goes to a specific recipient (doesn't have to be genetically related)
  • Non-Directed Donations - Altruistic

The Human Tissue Act of 2004

Came in response to the Alder Hay scandal

Consent is brought in right at the heart of things

There's a stance against commercialisation there: The law has taken a moral stance here, there's something sacred about the body

Guiding Principles

  • Consent
  • Dignity - there's a symbolic significance to the body, where you retain a right to dignity after death
  • Quality - safe practice
  • Honesty + Openness - in response to alder hey etc

Consent in this comes from the current common law and mental capacity legislation. There's nothing unique about consent in organ donation.

Consent is permission, not obligation.

In theory, in England and Wales, children can donate organs. Here there is a difference with common law. It starts with the assumption that the child has capacity, not the child has incapacity. In assessing a childs competency, we use Gillick competence

In practice, doesn't really happen.

Procedure

  • no money
  • reasonable consent

both need clarified before any operation occured

Child living organ donation HAS to go to court, this is an additional hurdle for the child versus adult

Case Law

Re Y

Y was a 25yr old woman with physical and mentally disabled. Sister required a bone marrow transplant. Other relatives weren't a match.

Should Y be tested to find out if a match?

Court said yes