Potential for organ donation in the United Kingdom

The biggest obstacle to improving the organ donation rate in the United Kingdom is the number of relatives who refuse consent, say researchers in this week's British Medical Journal.

The United Kingdom has a serious shortage of organs for transplantation, as does almost every country. The donor rate in 2004 was 12.3 per million population, which is one of the lowest rates in Western Europe. Spain has an exceptional rate of 33 per million population, but most other European countries have rates between 13 and 22 per million population.

Researchers at UK Transplant carried out a two-year audit of all deaths in 341 intensive care units in 284 hospitals across the United Kingdom. This is the first comprehensive, UK-wide study to try to identify the number of patients dying in intensive care units who could donate their organs for transplantation.

Over the two year period, families of 94% of patients who could have been organ donors were approached for consent to donation.

A total of 41% of the families denied consent. The main reasons given included "relatives did not want surgery to the body," "relatives not sure whether patient would have agreed to donation," and "relatives divided over decision."

The refusal rates for families of potential donors from ethnic minorities was 70%, twice that for white potential donors (35%), but the age and sex of the potential donor did not affect the refusal rate.

The maximum achievable potential donor rate during this study period was 23.2 per million population per year.

Intensive care units are extremely good in considering possible organ donation from suitable patients, say the authors. The biggest obstacle is the high proportion of relatives who deny consent.

However, when the Human Tissue Act comes into force in September 2006, the wishes and consent of the individual will be paramount. This may, in time, address this aspect and emphasises the benefits of increased registrations on the NHS organ donor register, they conclude.

http://www.bmj.com