Organ donation in the UK: a survey by a British Transplantation Society working party.

Introduction Background. During the past few years the number of organ donors in the UK has declined after a slow but In 1975 an editorial on the donation of kidneys in the steady increase during the 1980s. Concern about the British Medical Journal contained the concluding statedecline led to a survey by the British Transplantation ment: ‘With better co-operation from the public and Society. The report of this survery highlighted a medical profession more than enough kidneys could number of reasons for the decline and this manuscript easily be provided’ [1 ] Twenty years later, that predicpresents and discusses the main items in the report. tion is seen to be very wide of the mark. The idea that Methods. Comprehensive information relating to there was a large untapped source of donor organs organ donation was obtained by a combination of within intensive care units ( ICUs) was not supported structured interviews during visits to intensive care by the nation-wide audit of ICU deaths in England units (ICUs) and neurosurgical units, the use of reported by Gore et al. in 1989 [2 ], although it should detailed questionnaires sent to all UK ICUs, and from be noted that this audit was limited to patients where the register held by the United Kingdom Transplant brain-stem death was the actual or a possible diagnosis. Support Service Authority. Also in the years following this audit, there was a Results. The information obtained highlighted a decrease in the organ donation rate in the UK at a number of reasons for the decline in organ donor time when declines were also being experienced in most numbers and these are presented and discussed. The European countries, with the notable exception of pool of potential donors is shrinking as death rates Spain [3]. Concern about this decrease led to the from road traYc accidents and intracranial haemor- establishment of a working party of the British rhage decrease. Also the increasing use of modern Transplantation Society which had the remit of explorimaging techniques has improved predictive ability in ing some of the key problems underlying the process patients with severe brain damage with the result that of organ donation in the UK. A comprehensive review more patients whose prognosis is assessed as hopeless of the policies and practices relating to organ donation are not treated by ventilation. Inadequacies both in was carried out, and based on this eight recommendaintensive care unit bed provision and the resourcing of tions were made which, if implemented, should lead to the transplant co-ordinator service were also thought an increase in organ donor rates. While this survey to be important. has been carried out in the UK, most of the factors Conclusions. Eight recommendations have been made, contributing to the organ donor shortage and the covering ICU bed provision, neurosurgical provision, recommendations aimed at improving donor rates transplant surgical staYng, the transplant co-ordinator apply much more widely. network, reimbursement to donor units, asystolic donation, live donor transplantation, and interventional ventilation. Subjects and methods