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Opt out organ donation

title: WoS Regional Teaching - Organ Donation - Opt Out tags: FFICM notebook: 🌑-FFICM

Speaker: Lesley Logan

The legislation was supposed to come in last year but didn't because of covid, wasn't felt appropriate for the time as everyone was dying and they couldn't get into units.

The improvement of organ donations in the last few years is because we asked more people not because the proportion had got any better.

The new legislation in Scotland is expected to add another 15-20 patients per year.

There are about half the population on the Organ Donor Register in Scotland

About 12 families a year in Scotland overrule the patients decision to be an organ donor.

This is the approach in the new law, to protect your wishes after you die.

March 25 2021 is when the law comes into account.

There will allways be variation in the country as to which units refer what, as it depends on case mix. Some units are more head injury focused.

Human Tissue (Authorisation) Act (Scotland) 2019

(remember the human tissue authority don't apply in scotland)

Authorisation

We don't take consent in Scotland, we take Authorisation (reason authorisation is used in scotland rather than consent is cos you cant get informed consent from a dead person)

  • Duty to enquire
  • Duty to get evidence
  • Authorisation

Duty To Inquire

There is now a legal duty to have these conversations with families. It's about gathering information.

To ensure the donors "latest views are brought forward"

To ensure donation doesn't go ahead if it goes ahead their latest known views

Provides assurance for clinicians that checks have been undertaken

Now the nearest relative is not the same as the next of kin. But also from any other relevant person.

It's the nearest relative who makes the final decision though, and legally they're ranked.

This inquiry needs to happen before ANY predeath procedures. The aim is to be as open and transparent as possible.

What you want to know:

  • Is there express authorisation/opt Out
  • Are they in an excepted category (those under 16, those with incapacity, those who wouldn't normally be resident in Scotland)
  • Most recent view of donor
  • Most recent view of donor on predeath procedures

What if there's no one to enquire of? No loved ones/relatives? The only way authorisation can go ahead if there is express authorisation (written) by patient.

Authorisation

  • Express (Self)
  • Deemed
  • Nearest Relative
Express

Where the patient has joined the organ donor

You can also expressly refuse authorisation

Express = written

Deemed

Deemed is when not recorded decision either way in writing.

You can't deem someone if:

  • Express decision made
  • Evidence of unwillingness to donate
  • Evidence of patient being in excepted category (child, not resident, etc)
  • Transplantation is of excepted body part

The default position is if you're in any doubt of these safeguards then you approach the nearest relative

Nearest Relative

If you can't get express, or deemed, then you need to approach Nearest relative.

  1. Adults Spouse/Civil Partner
  2. Living with Adult in Relationship for At Least 6 Months
  3. Adults child
  4. Adults Parent
  5. Adults Brother or Sister
  6. Adults Grandparent
  7. Adults Grandchild
  8. Adults Uncle/Aunt
  9. Adults cousin
  10. Adults Niece/Nephew
  11. A friend of longstanding of the adult

This is the order for who you approach

So if you opt out you can also change your mind on that too.

Children

Authorisation does not apply to Children

It needs to be parents to authorise, or the person who holds parental responsibility.

There is a common calamity clause for if the parents aren't able to express their views.

Pre-death procedures

There is a framework for tests pre death

Publicity marterials need to include stuff for public knowledge about the procedure, to help with public consent.

Before this you need to confirm:

  • Dontation is authorised
  • No suggestion patient would have objected
  • The procedure is considered necessary (to increase chances of successful transplant)
  • Carrying out procedure needs to be mionimal

There are type A and type B procedures listed in act. If it's not listed it cant be carried out.

These procedures can only be carried out if death is imminent.

Type A:

  • Blood
  • Urine
  • X Rays
  • Lines are permitted for bloods

What's changed here is that now you need to do all the authorisation stuff first, whereas previously they would have been sent off before conversation.

This is helping public in terms of transparency but may delay things a little bit.

Authorisation for these procedures is deemed by either express authorisation of donation, or deemed, or nearest relative.

Type B

No list yet due to COVID/Brexit stopping parliament sign them off.

These will be requested by transplant surgeon, and will be including:

  • Bronchoscopy
  • Skin Biopsies
  • Biopsies of body other than ears, nose, and throat
  • CT Scan

They will need express permission by nearest relative.

So a predeath procedure is one that "facilitates transplantation, not supporting the patients health"

Any comfort procedures must continue as usual.

Updates/Duties

So this act is updating the 2006 act, and takes DCD more into account

  • Responsibilities for ministers perspective