Organ and tissue donation
Helping patients and families to make choices
Magi Sque and Joanne Wells
Human organ and tissue transplantation has proven to be an economically viable and successful therapy that extends life expectancy and improves the quality of life of individuals with certain severe medical conditions or irreversible organ failure. The demand for cadaveric organs is growing worldwide, to give health benefits to certain individuals. The supply of organs and tissues for transplantation has not kept pace with demand and the medico-surgical success of transplantation is limited by the low availability of organs, giving rise to an escalating number of preventable human deaths. Concomitantly, innovations in mechanical and bioengineered organ replacements remain problematic and protracted. In part, the shortfall in donations reflects an increase in the number of individuals who could benefit from a transplant. In this chapter, we draw mainly from UK data and practices.
On 30 March 2003, there were 5653 people in the UK waiting for suitable organs, while there had only been 772 cadaveric donors during the previous 12 months.1 Corneal donations throughout the UK have fallen by 30 per cent since 1995, forcing the cancellation of sight-saving operations.2 Over the next few years, it has been estimated that there will be a 30 per cent increase in the number of patients with end-stage renal failure (Royal College of Surgeons 1999). Roderick et al. (1998) predict that renal replacement costs will increase by up to one-third by 2011 and that there will be an increase in the liver transplant waiting list from 11 per million to 14–18 per million. There are two reasons to increase organ and tissue donation rates. First, to halt unnecessary deaths and to improve the quality of life of certain individuals. Second, to stem the increased demand on British National Health Service (NHS) resources as the population ages and more people are added to transplant waiting lists.
The cost to the NHS of alternative therapies (e.g. renal dialysis), which