1. October 2012S B Chetwynd – Human Organ Use1 The use of human organs and tissue for medical treatment Dr Sue Chetwynd Associate Fellow Warwick University

2. October 2012S B Chetwynd – Human Organ Use2 Session Outline Overview Morality of organ and tissue donation Legal position Procurement of organs and tissue Distribution of organs and tissue

3. Overview Types of tissue use Organs and parts of organ – heart, lungs, liver, kidneys etc. Gametes – sperm, oocytes Other tissue – blood, bone marrow etc. Replaceable/irreplaceable Purposes Life saving Life enhancing Life prolonging Life creating October 2012S B Chetwynd – Human Organ Use3

4. Morality of donation of parts of body Does our body belong to us? Is donation self-mutilation? Is it acceptable, praiseworthy or a duty to donate? Is there a moral difference between donating replaceable and irreplaceable tissue? Or donation for different purposes? Is there a moral difference between donation and sale? October 2012S B Chetwynd – Human Organ Use4

5. Human Tissue Act 2004 Regulates removal, storage and use of human tissue Lists the purposes for which consent is required (the Scheduled Purposes). Specifies who may give consent for the Scheduled Purposes. Creates a new offence of DNA theft Makes it lawful to take minimum steps to preserve the organs of a deceased person for use in transplantation while steps are taken to determine the wishes of the deceased, or, in the absence of their known wishes, obtaining consent from someone in an appropriate relationship. October 2012S B Chetwynd – Human Organ Use5

6. Appropriate consent Adults Living adult (aged 18 or over) consent must be explicit, given by the adult, and comply with the requirements of a valid consent. Deceased adult. For anatomical examination or public display, only the explicit consent in writing and witnessed of the deceased person prior to their death For other purposes – the consent of The deceased before her death, Her nominated representative(s), Or someone in a ‘qualifying relationship with her immediately before she died October 2012S B Chetwynd – Human Organ Use6

7. Appropriate consent Children For a living child appropriate consent is the consent of the child if he or she has given valid consent. Without this, consent should be by someone with parental responsibility for the child. When a child has died the following consents apply: For removal, storage or use of body parts for public display or anatomical examination the consent of the child (witnessed and in writing) when alive is required. For other Scheduled Purposes the consent of the child prior to death, if valid Without this, then consent from someone with parental responsibility If no such person, then someone in a qualifying relationship with the child October 2012S B Chetwynd – Human Organ Use 7

8. Types of living organ donation Directed donation To a specified person Paired Pooled donation Altruistic (non directed) donation Note: Directed donation is not permissible in cadaveric donation October 2012S B Chetwynd – Human Organ Use8

9. Procurement of organs People make decision for organs to be used after death (opt in system) Families make decision after death – includes required request State authorises use of organs unless donor (or family) objects Choice to opt in or opt out Person donates live organ or tissue Sale of organs Live Cadaveric October 2012S B Chetwynd – Human Organ Use9

10. Opt in systems Values autonomy – as long as family cannot override decision Allows for religious and other objections Inadequate supply for present needs But need to check for record of donation intention October 2012S B Chetwynd – Human Organ Use10

11. Family decision Difficult time to approach family May enable them to feel something good comes out of death Enables families feelings to be valued Families are source of information about the deceased which may be useful Recipients like to know family are happy with decision October 2012S B Chetwynd – Human Organ Use11

12. Opt out system May increase supply Still allows for autonomy – again if not overridden by family Raises worries about State ownership of bodies Trust between doctors and patients – Best Interests Definition of death October 2012S B Chetwynd – Human Organ Use12

13. Live donation Only possible for replaceable or surplus tissue (kidney perhaps a special case) Often involves near family May be concerns about undue pressure And proper appreciation of health risks in case of kidney and oocytes October 2012S B Chetwynd – Human Organ Use13

14. Sale of organs and tissue Usually discussed in context of live organ or tissue donation But could apply to cadaveric organs – payment to donors estate Assumed it will increase supply Worries about exploitation, commodification and fairness of distribution October 2012S B Chetwynd – Human Organ Use14

15. Distribution - organs and tissue Directed donation only allowed in live cases in UK Why not generally? Could we operate the same system with sale of organs/tissue? Allocation according to Need Dessert Previous benefit October 2012S B Chetwynd – Human Organ Use15

16. Other issues Identity issues Determination of death Compensation in kind? October 2012S B Chetwynd – Human Organ Use16

17. Conclusions Present supply is inadequate Not clear what changes might increase supply People have strong feelings about their bodies and those of relatives Respect for autonomy Altruism and gift giving are valued Worries about exploitation and commodification Determination of death October 2012S B Chetwynd – Human Organ Use17