For the 18th year in a row, Spain leads the world in the number of deceased organ donors per million people -- 34.3. This is a commonly used benchmark of the effectiveness of a donor system and other countries lag far behind. The average for the European Union is 18.1 and in the US it is 26.3. In the UK, the figure is 14.7 and in Australia 12.1 donors per million. The Spanish are particularly proud of their record, which was achieved despite a steady decrease in the number of traffic deaths, a major source of organs. What is the secret of the Spanish system? Dedication and teamwork.In 1989 the government set up a national network of transplant coordinators. They work in all hospitals and closely monitor emergency wards to be aware of potential donors. When they learn of a death, they tactfully try to persuade relatives to allow the person's organs to be harvested. Only about 15% of families refuse consent nowadays, a huge drop from 40% before the system was set up.
Cash incentives and the payment of funeral expenses are two ideas being put forward to encourage people to donate human organs and tissue. The Nuffield Council on Bioethics is asking the public if it is ethical to use financial incentives to increase donations of organs, eggs and sperm. Paying for most types of organs and tissue is illegal in the UK. The public consultation will last 12 weeks and the council's findings will be published in autumn 2011.
US scientists have created working liver grafts in the lab, and say the research could one day allow the growth of livers for transplant. There is a shortage of liver donors, but so far it has been difficult to grow replacement organs. In the work, published in Nature Medicine, a team from Massachusetts General Hospital, created successful grafts using rat cells. A UK expert said it was "a big step in the right direction".
Britain’s Orthodox Jews have been plunged into the centre of an angry debate over medical ethics after the Chief Rabbi ruled that Jews should not carry organ donor cards in their current form. London’s Beth Din, which is headed by Lord Jonathan Sacks and is one of Britain’s most influential Orthodox Jewish courts, caused consternation among medical professionals earlier this month when it ruled that national organ donor cards were not permissible under halakha (Jewish law). The decision has now sparked anger from within the Orthodox Jewish community with one prominent Jewish rabbi accusing the London Beth Din of “sentencing people to death”.
The number of organ donors and transplantations fell last year in Spain, the country that leads the ranking in both and whose transplantations model was recently adopted by the EU. The decline—which signals a break in the increase seen in recent years—was caused largely by a sharp reduction in deaths from traffic incidents. Improved management of cerebral infarctions and a small increase in the refusal rate to donate organs among families whose relative has died have also contributed to the fall. The reluctance to donate is particularly widespread among the immigrant population. The number of organ donors in Spain dropped from 34.4 per million inhabitants in 2009 to 32 million in 2010, while the total number of registered donors fell from 1606 in 2009 and 1502 in 2010, reports the Spanish National Transplant Organisation. This reduction is the largest seen in the past 20 years.
The United Kingdom’s chief rabbi, Jonathan Sacks, has issued an edict that carrying donor cards is unacceptable and that the current organ donor system is incompatible with Jewish law. The ruling comes after years of debate among rabbinical authorities over the definition of death and when an organ may be removed for transplant purposes. The new statement from the chief rabbi and his rabbinical court, the London Beth Din, says that organs may be removed for transplantation only at the point of cardiorespiratory failure, rather than at brain stem death. The latest figures for 2010 show that 66% of donations came from donors after brain death and 34% from donors after cardiovascular death, NHS Blood and Transplant said.
The number of patients in Israel who die while waiting for a transplant rose last year, and the number of transplantations fell by 20%, the annual report of the Ministry of Health’s National Transplant and Organ Donation Centre has said. As a result the shortage of organs has become more acute. Rafi Biar, chairman of the centre’s steering committee and director of the Rambam Medical Centre in Haifa, said that the main cause of the decrease is a new law that changed the protocol for defining “brain death” after discussions with the Chief Rabbinate. According to Jewish law death can be determined only after cardiopulmonary failure, and until recently the Chief Rabbinate had prohibited organ donation, as it did not recognise brain stem death. However, in 2008 the Israeli parliament passed a law that defines “brain respiratory” death as an indication of death for all legal purposes and also outlined the procedure that should be carried out to ensure that death had occurred.
All German citizens who apply for identity cards, driving licences, and health insurance cards will have to declare their wishes concerning organ donation under a new law being prepared by the German parliament.
An investigation is under way into how two transplant patients were given kidneys from a donor with a rare and aggressive form of cancer. The incident at the Royal Liverpool University hospital involved organs from a woman who died at another hospital, and was later found to have had a hard-to-identify disease called intravascular B-cell lymphoma. Both patients had been preparing for live transplants from their sisters but accepted the donor kidneys instead. The recipients are now receiving chemotherapy treatment. Although cancer transmission is a known risk of transplantation among clinicians, the case raises questions about guidance to patients and whether sufficient checks are made. One senior of
NHS Blood and Transplant associate medical director Professor James Neuberger said transfer of malignancy was a very rare occurance but more organs were likely to carry diseases as donors get older. He admitted the scale of the problem was not known. A research fellow has now been appointed to find out how often infected organs are passed on to patients. Professor Neuberger said his first role was to try and get all the data together from transplant centres and then to work out strategies with clinicians to reduce risk.
When Penny Wark's brother died last year, her family did not hesitate to donate his organs. Despite the trauma, she thinks it was the right decision - but says grieving relatives must be treated with more care.