Time to introduce organ donation to the concept of precision?

Abstract

Last week, the UK Organ Donation and Transplantation Activity Report for 2014/15 showed that the number of people receiving organ transplants in the UK decreased for the first time in more than a decade, prompting NHS Blood and Transplant to issue a plea for a national conversation about organ donation.This year's activity breakdown highlighted the fact that the number of people who chose or were able to donate their organs in 2014 fell, and that 224 fewer people in the UK received an organ transplant than the year before. Two figures were singled out for attention. First, no appreciable rise has occured in the proportion of families who gave consent to organ retrieval following the death of a relative, which continues to hover “stubbornly below 60%”. This flatline is coupled to a sharp drop-off in the number of people who died in circumstances in which they were deemed eligible to donate their organs (8157 in 2013–14 vs 7450 in 2014–15), following straight on from a record-breaking 10% increase in transplant operations in the previous year.In 2014, 6% of organ retrievals resulted in no transplants at all, compared with 4% in the previous year. So perhaps it is now time to reframe the debate away from changing belief systems around the gifting of our organs, towards the introduction of precision and rationalisation to the undoubtedly complex but occasionally haphazard, surgeon-level decision-making process that ultimately dictates the use and rejection of the tissues harvested from our recently departed loved ones. Although the number of used deceased donors was 18·8 per million population in 2014, the number authorised for organ retrieval was 29·9 per million people and there are still no nationally agreed age criteria for kidney and liver donation in the UK. As Rafael Matesanz, Director of Spain's world-leading Organización Nacional de Trasplantes, recently reminded us, we should “…never blame the population. If people donate less, it must be something we have done wrong”. Last week, the UK Organ Donation and Transplantation Activity Report for 2014/15 showed that the number of people receiving organ transplants in the UK decreased for the first time in more than a decade, prompting NHS Blood and Transplant to issue a plea for a national conversation about organ donation. This year's activity breakdown highlighted the fact that the number of people who chose or were able to donate their organs in 2014 fell, and that 224 fewer people in the UK received an organ transplant than the year before. Two figures were singled out for attention. First, no appreciable rise has occured in the proportion of families who gave consent to organ retrieval following the death of a relative, which continues to hover “stubbornly below 60%”. This flatline is coupled to a sharp drop-off in the number of people who died in circumstances in which they were deemed eligible to donate their organs (8157 in 2013–14 vs 7450 in 2014–15), following straight on from a record-breaking 10% increase in transplant operations in the previous year. In 2014, 6% of organ retrievals resulted in no transplants at all, compared with 4% in the previous year. So perhaps it is now time to reframe the debate away from changing belief systems around the gifting of our organs, towards the introduction of precision and rationalisation to the undoubtedly complex but occasionally haphazard, surgeon-level decision-making process that ultimately dictates the use and rejection of the tissues harvested from our recently departed loved ones. Although the number of used deceased donors was 18·8 per million population in 2014, the number authorised for organ retrieval was 29·9 per million people and there are still no nationally agreed age criteria for kidney and liver donation in the UK. As Rafael Matesanz, Director of Spain's world-leading Organización Nacional de Trasplantes, recently reminded us, we should “…never blame the population. If people donate less, it must be something we have done wrong”.