This is an explanation of the measures that transplant units should take when preparing living organ donors for the very rare possibility that their organ/part organ (which is otherwise transplantable), cannot be transplanted into the intended recipient. The purpose of this process is to ensure that living donor organs are not “wasted”.
The Human Tissue Act 2004 (Persons who Lack Capacity to Consent and Transplant Regulations) 2006 (the Regulations) requires the donor’s consent for a specified purpose.
Under Section five of the Human Tissue Act 2004 (the HT Act), if a surgeon proceeds to redirect an organ to an alternative recipient without the consent of the donor, this may be a criminal activity. A person guilty of an offence under Section 5 is liable to imprisonment for up to a year and/or a fine.
Where a donor has not consented to donate the organ to an alternate recipient or to research, the organ would have to be re-implanted or disposed of. Without consent, the re-direction of an organ cannot take place. Whilst this situation is extremely rare, if the donor's decision is not known in advance of the surgery; this could result in a viable organs being 'wasted' and in turn, pose a potential risk to the living organ donation programme.
All transplant units should ensure that the wishes of living donors on the alternative use of the organ in advance of surgery is asked and noted. The donor’s wishes must be documented in section five of the statutory referral letter. Transplant Units must ensure that their discussion with the donor is clear and explains that this specifically relates to the scenario where the organ, which although transplantable, cannot be transplanted into the intended recipient.
These are the available options:
- organ can be transplanted into an alternative recipient waiting for a transplant on the national waiting list;
- organ can be re-implanted into the donor (this option is not appropriate for liver lobes. In addition, paired/pooled donors and non-directed altruistic donors are advised that this may not always be possible if their organ is already being transported);
- organ can be used for research; or
- organ can be disposed of.
Surgeons must follow the donor’s wishes in the rare event that the organ cannot be transplanted into the intended recipient.
The donor’s wishes are also discussed during the interview with the Independent Assessor (IA) and recorded in the report submitted to the HTA. If the donor has not made a decision or was not provided with the relevant information, the Living Donor Coordinator (LDC) should be informed before the interview. It is not the IA’s responsibility to provide information to donors about their available options. LDC's should ensure, where possible, that the donor has made a decision in advance of their interview. If a donor is undecided about their wishes at the time of referral, this should be documented under section five of the referral letter. If the donor is still undecided following the interview with the IA, the IA should document this in their report to the HTA.
In cases of NDAD, the donor has already given consent for their organ to go to an unknown recipient. The HTA considers it unlikely for a NDAD to choose any other option other than re-direction of their organ to another recipient. As good practice, transplant teams should also seek consent from the donor to use their organ for research; that is, if the organ is damaged during retrieval and cannot be transplanted. This consent must be filed in the donor’s medical notes, as it is important to ensure that where the organ cannot be utilised for transplantation, there is valid consent in place for its use in research.
If a donor requests, in advance, to re-direct their organ to a secondary recipient; the HTA would need to be satisfied that there is no duress, coercion and reward involved in the re-direction. For example, a father donating to his child at the same time that his wife also requires a transplant. In the unlikely event that the organ cannot be transplanted into the child, he may wish for the organ to go to his wife instead.