I was lucky enough to spend the best part of a decade working for the Human Tissue Authority (HTA) in a variety of roles. However, my favourite role (don’t tell the other roles…) was managing the living donation assessment process and overseeing policy implementation in organ donation more widely. This was why, on relocating to the West Midlands in 2017 and taking up a role at University Hospitals Birmingham (UHB) I wanted to volunteer as an Independent Assessor. While my first six years as an NHS employee has been something of a baptism of fire, I have continued to get a huge amount out of being an Independent Assessor and contributing in a small way to lots of people’s donation stories (40 in total the online portal tells me).
The days of me knowing the wording of the legislation off by heart are long gone, but at the core of the role of an Independent Assessor is making sure that the potential donor is entering into the arrangement freely, without inducement, and with full knowledge of what will happen during the operation and the risks involved. This protection in this form was brought into law in 2004, and since then the way donors and recipients might meet, and the opportunities to find potential matches through the National Kidney Sharing Schemes have expanded rapidly. As an Independent Assessor it is important to keep up to date. The HTA supports this through regular newsletters and direct updates, as well as online training materials. I have also found it useful to have regular contact and engagement with the brilliant living kidney donation team at UHB, who provide a valuable operational viewpoint.
One of the delights of having worked in and around living organ donation for so long, is that I know that the background, experience, and personality types of Independent Assessors is hugely varied. There are clinicians, operational staff, administrators, legal advisers, chaplains, people from outside the NHS, and retired folk from many of these roles. There are extroverts and introverts, there are those with an eye for detail and those who prefer to take a more expansive view, the direct questioners and the have-a-longer-conversation types. What all Independent Assessors have in common is a keenness and ability to listen and hear what is really being said. To allow people to tell their own stories and feel safe doing so, and to ask probing questions when needed. Of the 40 donors I have spoken with, post-covid largely via a video call rather than face to face, I have always been struck by how many different ways people come to make such a significant decision and their reasons for doing so. There are often tears, most people express some fear, but mainly there is hope and drive to take a positive step to improve someone else’s life. There have been occasions where I have had concerns, and the HTA has been hugely supportive in such cases and worked directly with me and the team at UHB to agree next steps.
On reflection and having been part of the team that delivered Independent Assessor training for years, a slightly surprising one, it’s harder than I thought it would be. Being an Independent Assessor uses a very different set of skills than my day job and I have rarely had the need or opportunity to speak directly with patients during my career. The responsibility I feel when undertaking the assessment interviews and completing the online form which is submitted to the HTA for a decision is huge. It also reminds me in my day job (which involves supporting the successful embedding of genomic medicine into the NHS) that the people who matter are the patients; however well drafted a pathway or process looks on paper, if it doesn’t work for patients, we’re letting them down and failing to deliver the best care possible.
While things are undoubtedly tough in the NHS at present and most of us have more than enough to fill our days, I would urge anyone considering becoming an Independent Assessor to do so. The training provided by the HTA is brilliant and gives you lots of space to ask questions and a cohort of peers to keep in contact with. The fab Transplant Team at the HTA are quick to respond to queries and when more detailed consideration of a way forward has been needed, have worked really closely with me. Living Donation teams in NHS Trusts are unfailingly supportive of their Independent Assessors. You get to meet a wide range of people and get a boost from knowing you’ve contributed in a small way to a huge undertaking in someone’s life. And you get to support organ donation, and while I rarely see the impact it has had for the people I interview; I know through friends and the media just how life changing it is and am lucky to be able to contribute.
Vicky Marshment
Independent Assessor
If you would like to know more about becoming an Independent Assessor please
email: transplants@hta.gov.uk or read our guidance on living organ donation assessments.
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