Ethics briefings

Living organ donation in the UK

The prospect of new regulation is often met with reluctance and legitimate fears of additional bureaucracy for very little benefit. Changes to the approval procedure for living organ donation in the UK, however, appear to have made a real, and positive, difference to the practice. The Human Tissue Act 2004 abolished the Unrelated Live Transplants Regulatory Authority (ULTRA) and handed responsibility for overseeing living donation to the newly established Human Tissue Authority (HTA). On paper, the new system appeared to be a significant improvement on the old one. It removed the illogical disparity between related and unrelated donors. Previously only donations from unrelated individuals needed prior approval and evidence of a genetic link was a green light to proceed without further investigation, suggesting, erroneously, that donation within families was always voluntary and free from pressure and coercion. While the reasoning behind this distinction was obvious—coming as it did in the immediate aftermath of the uncovering of an international trade in human organs—the logic behind the distinction was lacking. Although the list of permitted relationships was broad (including uncles and aunts by half blood), donation between spouses, long-term partners or friends was subject to the full and frequently drawn-out approval process designed to prevent surreptitious payment.

Now all living organ donation needs prior approval but the system has been streamlined to avoid the long delays that became synonymous with the old system. Under the new regime:

• Applications are reviewed at a local level by a group of “independent assessors” who have been trained and accredited by the HTA.

• The independent assessor must be satisfied that the person consenting to the donation has been given and understood the necessary information and that there is no evidence of reward or coercion or evidence that the person has been subjected to pressure to consent. …