Donation: ethics and worries

There are a lot of issues and fears surrounding organ donation. Here are some common questions and answers.

Will the doctors fight to save me?

Absolutely. The doctors looking after a patient have to make every possible effort to save the patient's life. That's their first duty. If, despite their efforts, the patient dies, organ and tissue donation can be considered. A completely different team of donation and transplant specialists will then be called in. 

How will they know I'm dead?

Organs are only removed for transplantation after a person has died. Doctors who are entirely independent of the transplant team will confirm death. Death is confirmed in exactly the same way for people who donate organs as for those who don't.

Most organ donors are patients who die because of a brain haemorrhage, severe head injury or stroke, and who are on a ventilator in a hospital intensive care unit. Under these circumstances, death is diagnosed by brain stem tests. There are very clear and strict standards and procedures for these tests, which are always performed by two experienced doctors.

The ventilator provides oxygen that keeps the heart beating and blood circulating after death. These donors are called heart-beating donors. Organs such as hearts, which deteriorate very quickly without an oxygen supply, are usually only donated by a heart-beating donor.

Patients who die in hospital but aren't on a ventilator can, in some circumstances, donate their kidneys and other organs. They're called non-heart-beating donors. Heart-beating and non-heart-beating donors can donate their corneas and other tissue.

Will I be left disfigured?

Organs and tissue are always removed with the greatest of care and respect for the person. This takes place in a normal operating theatre under the usual conditions. Afterwards the surgical incision is carefully closed and covered by a dressing in the normal way. Tissue can be removed in an operating theatre, mortuary or funeral home. Specialist healthcare professionals carry out the operation. They ensure that the donor is treated with the utmost respect and dignity. Only those organs and tissue specified by the donor or their family will be removed.

Is it possible to see the body after donation?

Yes. Families are given the opportunity to spend time with their loved one after the operation if they wish. The transplant co-ordinator will arrange this. Arrangements for viewing the body after donation are the same as after any death.

Does a donor's family have to pay the cost of donation?

No. There's no payment at all. The NHS meets the costs related to the donation of organs and tissue.

Does joining the NHS Organ Donor Register mean I am agreeing to donate my face or limbs for transplant?

No. We require specific agreement for these forms of donation, either from you, during your lifetime, or from your next of kin after death. Let those close to you know your wishes.

Can I agree to donate to some people and not to others?

No. Organs and tissue cannot be accepted unless they're freely donated. No conditions can be attached in terms of potential recipients. The only restriction allowed is which organs or tissue are to be donated.

Could my donated organs and tissue go to a private patient?

Possibly. However, patients entitled to treatment on the NHS are always given priority for donated organs. These include UK citizens, members of Her Majesty's forces serving abroad, and patients covered by a reciprocal health agreement with the UK.

Other people will only be offered an organ if there are no suitable patients entitled to treatment under the NHS. Every effort is made to ensure that a donated organ does not go to waste if there is someone who can benefit.

Donated tissue is made available to any hospital in the UK where there's a patient in need.

Could any of my organs or tissue be given to someone in another country?

Yes, possibly. There's an agreement that any organs that cannot be matched to UK patients are offered to people in other European countries. Likewise, UK patients benefit from organs offered by other European countries. This co-operation increases the chance of a suitable recipient being found, ensuring that precious organs do not go to waste. Tissue might also be offered to patients in other countries.

Are there religious objections to organ and tissue donation?

No. None of the major religions in the UK object to organ and tissue donation and transplantation. If you have any doubts, discuss them with your spiritual or religious adviser. In addition, the Organ Donation Directorate of NHS Blood and Transplant (Organ Donation) has produced a series of leaflets that focus on the six major religions in the UK.

Does the colour of my skin make a difference?

No. However, organs are matched by blood group and tissue type (for kidney transplants). The best-matched transplants have the best outcome. Patients from the same ethnic group are more likely to be a close match. A few people with rare tissue types may only be able to receive a well-matched organ from someone of the same ethnic origin, so it's important that people from all ethnic backgrounds donate organs.

Successful transplants are carried out between people from different ethnic groups wherever the matching criteria are met.

Is there any point in making a special appeal if someone desperately needs an organ?

Yes and no. Any special appeal usually results in more people agreeing to become donors and can increase the number of organs available. However, family appeals through the newspapers and television will not result in an organ immediately becoming available. The patient will still be on the transplant list, just like everyone else, and the rules that govern the matching and allocation of donor organs to recipients still apply.

Can I agree to donate some organs or tissue and not others?

Yes. You can specify which organs you would wish to donate. Simply tick the appropriate boxes on the NHS Organ Donor Register form or on the donor card. Let those close to you know what you've decided.

Will organs or tissue that are removed for transplant be used for research purposes?

Organs and tissue that cannot be used for transplant will only be used for medical or scientific research purposes if specific permission has been obtained from your family.

How is organ donation different from organ retention?

The problems of organ retention arose because proper consent was not obtained from parents or relatives for organs and tissue removed at post-mortem to be kept for research or other purposes. Because of these problems, the law was changed and the Human Tissue Act 2004 and the Human Tissue (Scotland) Act 2006 were introduced. Organs and tissue are only removed for transplantation if permission has been given.

Would a donor's family ever know who the recipient was?

Donation and transplantation is an anonymous process. Those involved may want to exchange anonymous letters of thanks or good wishes through the transplant co-ordinators.

However, over time and if both sides want to, NHS Blood and Transplant can facilitate written contact between donor and recipient and this can eventually result in face-to-face contact.

It's not always possible to provide recipient information to donor families for some types of tissue transplant.

Can people buy or sell organs?

No, the transplant laws in the UK absolutely prohibit the sale of human organs or tissue.

Can a deceased person donate sperm or eggs for future use?

While it is possible to retrieve sperm or eggs, it is illegal to store them or to create an embryo without the prior written consent of the donor.

Can someone with HIV or hepatitis C donate?

Yes. In very rare cases, the organs of donors with HIV or hep C have been used to help others with the same conditions. This is only ever carried out when both parties have the condition. All donors have rigorous checks to guard against infection.

Page last reviewed: 16/04/2013

Next review due: 16/04/2015

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The 1 comments posted are personal views. Any information they give has not been checked and may not be accurate.

Romanthony said on 14 February 2012

It should also be asked and answered that if a deceased person is on the organ donation register the NHS medical teams will encourage donation and only if there is strong and sustained opposition from the family then donation will not be made.

Of course if the BMA and others gain their wishes then patients will all be chosen to donate if they do not go through the hoops to opt-out of registration and that registration is correctly recorded and accessed.

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