Organ donation in the UK: how general practice can help

Abstract

Solid organ transplantation not only dramatically improves the length and quality of life of the recipients but also saves the NHS money.1,2 Organs routinely transplanted include heart, lung, liver, pancreas, and bowel but other organs that may be transplanted include thymus, hand, face, leg, abdominal wall, and uterus. The last two decades have seen major changes in organ transplantation: developments in surgery, anaesthesia, interventional radiology, microbiology, and pharmacology have transformed what many still today believe is a high intensity, high risk procedure with a high mortality to a routine procedure with low morbidity and a high long-term success rate. As the number of patients undergoing and surviving transplantation increases, GPs will see increasing numbers. However, transplantation activity is limited by donor availability. Organ donors may be living or deceased. Living organ donation is regulated across the UK by the Human Tissue Authority which ensures that donation is done ethically, legally, and without financial or other inducement. Most living donations are directed to a named recipient (usually a family member or close friend) but we are seeing a small but increasing number of altruistic donors who donate to strangers. Living donation is not devoid of risk to the donor: the risk of death for a kidney donor is of the order of 1 in 4000 but for a living liver donor, the risk of death is about 1 in 250. Deceased donation may occur after brain death (DBD; previously known as heart beating donors) or after circulatory death (DCD). A decade ago, the UK was very firmly in the lower ranking for organ donation (with donor rates of 12.0 per million population (pmp) in 2003 (Figure 1 …