Unrelated living organ donation: ULTRA needs to go
- International Forum for Transplantation Ethics, Royal Liverpool University Hospital, Liverpool, UK
- Correspondence to: Professor R A Sells, International Forum for Transplantation Ethics, Royal Liverpool University Hospital, Liverpool, L7 8XP, UK; robert.sells{at}rlbuh-tr.nwest.nhs.uk
- Accepted 12 January 2003
The recent review of the Unrelated Live Transplant Regulatory Authority (ULTRA) provides administrative and statistical information regarding living donor kidney transplantation in the United Kingdom.1 However, it leaves much unsaid. For example, although the report does mention the number of live kidney donations from unrelated donors that ULTRA has approved, (69 in 2002: S Pioli, personal communication, 2001) it fails to mention that the United Kingdom has a low live kidney donation rate compared with other European countries (in 1999, 5.3 kidney donors per million population in the UK; 8.7 in Switzerland, 11.5 in Sweden, 24.6 in Norway).2 More importantly, the report does not address the fundamental question of whether the legal framework underlying ULTRA is morally justified. The legal regime in the United Kingdom proceeds on the tacit assumption that genetically unrelated donors are much more vulnerable to coercion than are related donors, and hence are more in need of protective regulation. In this article, we argue that the distinction drawn in the United Kingdom between genetically related and unrelated donors is difficult to justify, that it unnecessarily discourages live organ donation, and that the law should be changed.
BACKGROUND
The Unrelated Live Transplant Regulatory Authority is a creature of the Human Organ Transplant Act (HOTA), which was enacted by parliament in 1989, and which came into force, with regulations, on 1 April 1990.3–5 The Human Organ Transplant Act was enacted hastily after the General Medical Council’s inquiry into the notorious case of a British physician’s involvement in transplants involving Turkish peasants.6 Young men were inveigled by an agent to travel to London, ostensibly to take up new jobs. In fact, they were being recruited as living donors of kidneys transplanted into fee paying foreign patients. The consequent debate in the media attracted an emotional …
