A question of give and take : improving the supply of donor organs for transplantation

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Transplanting organs from one human to another is increasingly constrained by a shortage of donors. This report describes the wide variations between the number of kidney and heart transplantations and those waiting for these operations both in the United Kingdom and internationally; and how the UK could improve its performance. Conclusions reached are: methods to reduce the rate of relatives' refusal by voluntary means do not offer scope for significant improvement over current levels of donation; presumed consent legislation is not recommended for immediate implementation due to a lack of consensus among the transplant community on the ethics and practicality of the policy, and the impact public disagreement could have on the standing of the transplant technology; elective ventilation has provided initial evidence of a substantial impact on donation rates; implementation of this procedure is recommended if legal and ethical questions relating to the interests of the potential donor can be resolved; there is substantial scope for improving kidney donation rates from live donors but carefully formulated guidance will be essential if this opportunity is to be taken without falling into unethical practices. Meanwhile available organs will need to be allocated fairly.

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