The use of human organs and tissue for medical treatment

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

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

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 S B Chetwynd – Human Organ Use

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? S B Chetwynd – Human Organ Use

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. S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use

16. Other issues • Identity issues • Determination of death • Compensation in kind? S B Chetwynd – Human Organ Use

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 S B Chetwynd – Human Organ Use