Farewell to a czar

Abstract

We are delighted to include in this issue a selection of papers relating to organ retrieval and transplantation. The journal has featured the subject of donation and transplantation several times in recent years, in part due to the interests of the editorial team, but also because it has been, and should remain, a topic of national concern and debate. The papers cover a range of issues and vary in style from the quantitative to the discursive and analytical and they are supplemented by a specially commissioned Five-Minute Focus on Law looking at the recent European Union Directive on Organ Donation and Transplantation. We are very grateful to the organizers of the Winter Ethics Symposium, ‘The ethics of organ retrieval: goals, rights and responsibilities’, hosted by the MRC Centre for Transplantation in December 2010, for working with us to produce a lasting record of a very successful meeting. It is timely that this issue of the journal will appear at the same time as an important figure in the field of transplantation will be starting his retirement, giving us the perfect opportunity to acknowledge his contribution to advancing the field of transplant medicine and public policy relating to organ donation and making sure that the complex ethical issues involved are recognized and where possible resolved. Mr Chris J Rudge was appointed to his first Consultant post in transplant surgery in 1981 and between 1994 and 2001 he was Director of Transplantation at The Royal London Hospital. He has always maintained his links to ‘The London’, continuing with a day a week clinical practice even when in 2001 he became Managing and Transplant Director of UK Transplant (UKT). At UKT, the task of improving the UK’s donation rates and assuring that the management of donors and the retrieval processes translated donations into transplants became the core of his day job, and he soon became aware that there was room for significant improvements in how we as a country approached the task of increasing the number of transplants and saving lives. In 2006, the Government established a taskforce under the chairmanship of Mrs Elisabeth Buggins. The task of the Taskforce was to remove obstacles to donation, doing so within existing legal frameworks. During the life of the Taskforce the English Director of Public Health, Sir Liam Donaldson, focused on the shortage of donor organs in his annual report of 2006, famously referring to the waiting game facing those in need of transplanted organs and urging a move towards an opt-out system of recruitment of donors. Chris played a vital role in supporting the work of the Organ Donation Taskforce (ODT) whose final report outlined 14 recommendations designed to increase donation rates by 50% in five years. Chris also supported the Taskforce when navigating the politically choppy waters of their subsequent work on opt-out. The recommendations of the ODT were accepted by the British Government in January 2008 and in announcing the implementation strategy for the Taskforce recommendations Professor Sir Bruce Keogh also announced Chris’s secondment to the Department of Health and his appointment as National Clinical Director for Transplantation. Many of the contributors to this issue will have had the pleasure of working with Chris – be it in the operating theatre, classroom or committee room. His personal commitment to improving the chances of people currently waiting for transplant is clear, and his work as a surgeon, medical educator and policy-maker has contributed significantly to the fact that we are making progress in reaching the 50% target. Chris has been the most English of czars, a thoughtful and courteous man who understands the need to engage and support colleagues in pursuing the goals set for them. He has personally gone to great lengths to acknowledge and address the ethical challenges facing colleagues in his own field, but even more importantly in the field of intensive care medicine. A gradualist rather than a revolutionary, Chris has tried to bring people along with him and make the task of increasing donation a shared endeavour. As a result, there has been ongoing dialogue at a local and national level between clinicians who have in the past found it difficult to understand each others’ perspectives. One of Chris’s lasting legacies will be the establishment of the UK Donation Ethics Committee, which was set-up as a result of the Taskforce’s recognition that Bobbie Farsides is Professor of Clinical and Biomedical Ethics at Brighton and Sussex Medical School. She serves on a number of national committees and lectures around the world on ethical issues related to her areas of interest, as well as serving on the Clinical Ethics Committee in Brighton and being co-editor of Clinical Ethics.