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About Transplantation

Organ donation and transplantation is the process of removing an organ from one person and implanting it in another. The organ being removed must be donated ('gifted'). Following a transplant, thousands of people take on a new lease of life in Scotland every year.

In the majority of cases, organs are transplanted from donors who have died, usually from severe brain injury. In a smaller number of cases, organs are donated by a living volunteer. This involves considerable risks to the donor and can only occur after very careful consideration. Kidney transplants are the most commonly performed. Transplants are regularly carried out on the heart, liver, lungs, pancreas and small bowel.

Tissue such as eyes, heart valves, skin, bone and tendons can also be donated and transplanted.

Today over 8,000 people in the UK are waiting for an organ transplant that could save or dramatically improve their quality of life.

Transplants are one of the most miraculous achievements of modern medicine. However, they depend on the generosity of donors and their families.

The increasing effectiveness of transplantation means that many more patients can be considered for treatment. More people also need a transplant, but there is a serious shortage of donor organs. For some people this means waiting, sometimes for years, and undergoing difficult and stressful treatment. For all too many, it means they will die before a suitable organ becomes available.

Legislation

In the United Kingdom two key laws govern organ donation and transplantation:

The Human Tissue (Scotland) Act 2006;
The Human Tissue Act 2004. (England, Wales and Northern Ireland)

The Human Tissue (Scotland) Act 2006 sets out the legal framework under which people can express their wish to leave parts of their body (organs and tissue) so that these can be used for transplantation after their death. Its main provisions are:

Any adult, or child aged 12 and over, who is able to make their own decisions, can give permission for their organs or tissue to be donated.
If you want to donate organs or tissue, this will be done in preference to any other requests which are made, for example leaving your body to medical science.
A person's own decision is the most important thing. A relative does not have the right to change this decision after the person has died.
Children under the age of 12 cannot give permission themselves. If a child under the age of 12 dies, only their parent or guardian can give permission for their organs or tissue to be donated.

At present, a person must express their wish to be a donor. This system is commonly known as 'opt-in'. A person who wishes to 'opt-in' puts his/her name on the NHS Organ Donor Register, maintained by NHS Blood and Transplant. This is a national, confidential list of people who are willing to become donors after their death. It can be quickly accessed by a specialist nurse in organ donations or other healthcare professionals to see whether an individual has expressed willingness to be an organ donor.

NHS Organ Donor Register

Besides telling family, relatives and friends of the wish to donate organs, there is also the National Organ Donor Register, held by NHS Blood and Transplant in Bristol. If someone wishes to donate organs after their death they can add their name to the Register.

This enables doctors, nurses and transplant coordinators to confirm an individual's wishes to the family, close relatives and close friends.

In Scotland around 65% of families agree to organ donation when asked. It is very rare for families to object if they knew that their loved one wanted to donate.

Ways in which people can express their wishes include:

Joining the NHS Lothian's Organ Donation campaign:
Online: https://www.organdonation.nhs.uk/
Text: Text "fifty" to 61611
Mobile phone app
Telephone: 0845 60 60 400
Telling their closest relatives or friends
Carrying a Donor Card
Writing it in a letter or document such as a will

What happens if a person's wishes are unknown?

If no wish has been expressed in life then specially trained healthcare professionals should approach the family for their authorisation to proceed, based on their knowledge of the potential donor.

The law gives further guidance and specifies a 'hierarchy' of relatives in the order in which the healthcare professional is expected to approach them:

Spouse or civil partner;
'Living with the person as husband/wife or in a relationship which has the characteristics of civil partners for a period of not less than six months;
Child
Parent
Brother or sister
Grandparent
Grandchild
Uncle or aunt
Cousin
Niece or nephew
Friend of longstanding

The need for transplants

People need transplants for many reasons.
The most common of these are:

Disease
Genetic disorder
Accident
Alcohol/drug abuse

What can be transplanted?

Organs - kidneys, heart, lungs, liver, small bowel, pancreas and islet cells.

Tissue - eyes, heart valves, bone, skin, connective tissue.

Organs and tissues from people in their 80s can be transplanted successfully - There is no age limit.

How quickly are organs transplanted?

Heart and lungs need to be transplanted within 4-5 hours of removal from the donor.
Ideally livers should be transplanted within 9-10 hours of removal from the donor and kidneys within 24 hours of retrieval.
Tissue can be stored in special banks for varying lengths of times.

How is transplantation organised?

The priority when any patient is admitted to hospital is to make them well again. Unfortunately, despite the best efforts of hospital staff this is not always possible and the focus of care can then change from making them better to managing their end of life care.

It is only after the medical staff make the decision that further treatment would be futile, that organ and tissue donation is considered as one of the possible end of life choices.

It is at this time that the specialist nurse in organ donation is contacted by the doctor caring for the patient. All specialist nurses have many years experience looking after patients in critical care units and caring for their relatives and friends. A specialist nurse in organ donation is based in each large hospital and is available to offer support and advice to all staff and relatives about end of life choices including organ and tissue donation. The specialist nurse in organ donation will check the Organ Donor Register to see if the patient had registered a wish to donate and assess the history of the potential donor to confirm that there are no medical or social barriers to donation. The specialist nurse in organ donation will also provide any information on the process of donation to the next of kin.

Role of NHS Blood and Transplant

The allocation of organs is the responsibility of NHS Blood and Transplant, which is directly accountable to all UK Health Ministers.

A key role of NHS Blood and Transplant is to ensure that donated organs are matched and allocated in a fair and unbiased way. Matching, particularly in the case of kidneys, is so important that donation and allocation need to be organised across the UK.