Brain dead patients could be kept alive to harvest their organs for NHS
Hospitals could be allowed to keep patients with massive brain injuries alive solely to harvest their organs, under controversial plans being floated by the NHS.
By Stephen Adams, Medical Correspondent
7:06PM BST 27 Jul 2012
The 19 million people on the Organ Donation Register could also be given preference in the event of needing an organ, over those who are not.
These are two of the proposals mooted in a consultation being carried out by NHS Blood and Transplant this summer.
NHSBT is canvassing views from health professionals and the public on these and other ideas in the online survey, which closes on September 21. If put into practice they would represent large-scale changes to the way transplant is undertaken.
The survey asks whether doctors should be able to keep alive patients with catastrophic brain damage, for example due to head injury or stroke, who will not survive, solely for the purpose of organ donation.
Patients approaching death are often put on artificial ventilation for a short period to enable their relatives to say goodbye.
However, what is being considered is different. Known as elective ventilation, it involves starting ventilation once it is recognised that the patient is close to death, with the specific intention of facilitating organ donation.
The ethically controversial practice is also being considered by the British Medical Association, which wants a debate on the issue.
Many transplant surgeons have concerns about it because it involves administering treatment to benefit another.
The survey asks if NHSBT should “review the ethical, legal and professional acceptability of so-called elective ventilation, ie intubation and ventilation of a gravely ill patient whose death is inevitable in order to promote donation after brainstem death.”
This procedure led to a 50 per cent jump in the number of organs available when it was carried out by the Royal Devon and Exeter hospital from 1988, but it was declared unlawful by the Department of Health in 1994. Spain and the US already use the technique.
The survey also asks: “Do you agree that a person who has signed up to the Organ Donation Register should be a priority recipient for an organ if they subsequently require a transplant?”
This approach is used in Israel to encourage people to become registered donors.
However, it would undermine a central tenet of the NHS: that patients are treated on the sole basis of need.
Sally Johnson, director of organ donation at NHSBT, told The Guardian: “It always seemed to me that fairness is quite a fundamental British value but we have never put that in the context of organ donation.”
On the question of elective ventilation, she said people needed to start thinking, if a dying person said they wanted to be an organ donor “should you do your utmost to facilitate their final wish?”
James Neuberger, associate medical director, said elective ventilation would only ever be used “if in each individual case the family and relatives also supported it”.
The survey asked if NHSBT should look again at presumed consent – in which people must opt out of being donors rather than opting in – or “mandated choice”, where they are required to make a choice one way or the other.
The two directors emphasised neither NHSBT nor the Department of Health endorsed the ideas, which were purely for consultation to inform future strategy.
Currently about 1,000 people in Britain die every year because no transplant organ is available.
Since 2007 there has been a 34 per cent increase in the number of deceased organ donors, and a 22 per cent increase in transplants.
But surgeons say this has come at a price of accepting lower quality organs from older, fatter people, because the number of people under 75 dying has dropped by 15 per cent in recent years.
Although about 500,000 people die in Britain every year, only about 3,000 die in circumstances where they could become donors.
Last year almost 4,000 organs were transplanted from some 2,150 donors