VOL: 98, ISSUE: 28, PAGE NO: 31
David Harley, MB, ChB, FRCA, DA, is chair, Transplants in Mind, and Consultant Emeritus in Anaesthetics and Intensive Care, University of SheffieldTransplants are an undoubted medical success story and have been instrumental in saving and improving the lives of thousands of people. We have come a long way since the first kidney transplant in 1954 to a point where we can use an astonishing number of body parts - both organ and tissue - to alleviate a wide range of conditions.
Transplants are an undoubted medical success story and have been instrumental in saving and improving the lives of thousands of people. We have come a long way since the first kidney transplant in 1954 to a point where we can use an astonishing number of body parts - both organ and tissue - to alleviate a wide range of conditions.
The worst problem faced by potential transplant patients is the shortage of suitable organs and tissues. The use of animal or artificial organs is a long way off and human donors are still the most practical source.
Judith Stewart (p32) highlights the problems of finding donors, particularly as the number of suitable hearts has not increased in spite of a change in policy that extended the maximum age for cardiothoracic donors to 65. The issue is also touched on by Neil Wrightson and colleagues, who describe the postoperative care of transplant patients (p34).
Although demand for solid organ transplants continues to fall, there is still a shortage of organs. The latest figures from Transplant UK show that 969 transplants of all types - from 317 donors - were carried out this year, while the number of people on the waiting list climbed to 9,616.
A lack of knowledge is largely to blame for a lack of donors, together with a certain squeamishness on the part of many people in contemplating their mortality. Yet even if all potential donors, who are generally to be found in intensive care units, could be used, there would still be a considerable shortage of solid organs suitable for transplant.
There is an urgent need to educate the public on the desirability of committing themselves to such a selfless act as donation, and a need to persuade medical and nursing staff to be prepared to be part of the process of donation. Many are reluctant to broach the subject with a potential donor's family during a time of acute distress. Yet research reveals that relatives who have agreed to donation subsequently derive comfort from the thought that, despite their loss, the transplant has helped others.
Education needs to be targeted at all levels of the population, from school upwards, so that organ donation is regarded as a normal part of life, much like giving blood.
I do not believe that compulsory methods, such as opting out, are viable. There is no evidence that they make a significant difference. Donation should be just that: the gift of life, freely given.
- See also PDNT: Heart failure, part 1, p41