Introduction:

Transplant developments occurred throughout the twentieth century. Disparate branches of medical science contributed to the process. No single individual can claim transplantation as their sole achievement. The idea of postponing death has been a perennial ambition of human beings over the centuries. Transplants of teeth took place in the eighteenth century. The first corneal transplant was successfully carried out in 1905. Living kidney donation kept Richard Herrick alive in 1954, to become the first successful kidney transplant recipient. Dr James Hardy completed the first successful lung transplant at the University of Mississippi Medical Centre in 1963. Christian Barnard extended the transplant programme with the first heart transplant in 1967 – Louis Washkansky living for 18 days following the donation of Denise Darvall’s heart.

Once the ‘genie is out of the bottle’ it is very difficult it put it back in! The transplant project has extended rapidly since the early 1980’s when anti-rejection medication led to transplanted organs lasting longer and giving greater quality of life for thousands of people in developed economies. In the twenty-first century surgical and biomedical techniques have progressed to enable face, hand, leg, trachea, ovary and pancreatic islet transplants to take place. More organs are needed for more recipients who are desperate to have their lives enhanced or saved by transplant operations.

Around the world the age old problem remains …… the demand for organs always exceeds supply.

This will always remain the biggest challenge facing the transplant programme. Faced with this dilemma there are people who believe that transplant procedures should not be made available to anyone unless they are available to all. This is a truly egalitarian view but one that attracts only limited support. If human beings have any rights at all, the right to life has to be paramount. The right to free speech or the vote or universal education are meaningless unless society preserves the right to life. Transplants save lives.

In this section of the website I want to discuss the key challenges facing society with regard to transplants and consider the potential barriers which need to be addressed.

• Why do large groups of people say they support organ donation but take no measures to demonstrate this by signing the Organ Donor Register?

• Why are so few organs retrieved from dead people even if they had signed the Organ Donor Register?

• Why do some social groups oppose donation on religious or cultural grounds?

• Should more investment go into animal husbandry to nurture organs from pigs that could be used in xenotransplants? (Xenotransplants are when organs are transplanted across different species e.g. baboon to human – whereas allografts are organs transplants between individuals of the same species i.e. human to human – isografts are the transplantation of organs between identical twins.)

• As organs are in short supply can there ever be a fair method of allocating a precious scarce resource such as a heart, lung or liver? What does ‘fair’ mean in this context?

• Can it be right to ask living organs donors to take risks with their health because we cannot retrieve sufficient organs from deceased donors?

• By definition deceased donors have died before their organs have been retrieved for transplantation purposes. If a person has expressed a wish to be a donor during their life time is it OK to intervene in that person’s process of dying so that their organs can be successfully retrieved?

• In most countries where organ transplants are carried out the relationship between the donor and recipient cannot involve payment of any kind. The relationship is based on altruism. In the UK it is illegal to give or receive financial reward as defined in legislation relating to the 2004 Human Tissue Act. The Human Tissue Authority - Code of practice 2 - ‘Donation of solid organs for transplantation’ explains the position very clearly in points 40 – 46. Financial transactions relating to organ donation can be punished with a three year prison sentence. But with the shortage of organs getting worse, is it time to consider introducing incentives to encourage more people to be donors?

Each of these issues will be considered over a period of time. They raise very difficult philosophical, moral, ethical, legal and religious questions. Harder still is the chance of establishing a consensus to answer these questions in a society that pays lip service to the support of organ donation, but which takes only limited steps in making it happen. Proof?? Just 4% of people regularly give blood in the UK, fewer than one million people are on any bone marrow register and just 30% of people are on the Organ Donor Register. Most of us acknowledge the right to life, but in terms of donating the bodily materials that enables this to happen the British are very reluctant to back sentiment with actions.

Should we be troubled by this? I think we should. I can identify with the pain and suffering of the patients who are desperately waiting for a lifesaving transplant operation. I have been through the process myself. The distress experienced by relatives and friends watching a loved one dying as they wait for a transplant that doesn’t happen in time is awful to watch when you know a solution is at hand if only…….

A callous view is to say that is their problem – it is not society’s responsibility. Yet an estimated one in nine families is directly affected by transplant issues. All UK citizens pay taxes that contribute to the maintenance of the National Health Service which has to care for people with end stage organ failure. If you examine the UK Renal Registry annual reports you will soon recognise the huge costs involved caring for dialysis patients whose lives could be dramatically improved and a much reduced cost to the nation if they received a kidney transplant. I am pictured below on dialysis during the winter of 2005-06 hoping to survive by receiving a heart and kidney transplant. During this brief period on dialysis several patients died for the sake of a kidney transplant. I was lucky. My lifesaving procedure took place in June 2006.[Link to the Renal Registry reports.]

If you look at the 2010 Renal Registry report that analyses the data for renal replacement therapy (RRT i.e. patients who needed some form of dialysis or a kidney transplant to stay alive) in 2009 the picture is not good. Patients with established or end stage kidney failure increased by 3.2% over the previous year. In 2009 6,730 people started on RRT. The total number of people on dialysis increased to 24,325* patients at an estimated annual cost of about £40,000 per patient (equivalent to about £1 billion per annum?).

Of the 24,325* dialysis patients 7,174 were listed for a kidney transplant (in some cases patients needed other organs as well). According to the UK Transplant Activity report for 2008-09 2,497 transplants involving a kidney were carried out. This included 859 deceased donors providing 2,044 kidneys and 927 living donor kidneys.

This was an annual shortfall of 4,203 kidney procedures. Consequently 632 kidney patients on the transplant list died waiting. But what about the other 17,151 dialysis patients not even on the kidney transplant waiting list? The human cost of this situation is terrible. The financial cost is a ludicrous waste of public funds. Kidney transplants cost a lot less than dialysis as a renal replacement therapy - estimates claim a saving of £250,000 per kidney transplant over the life time of the graft. For the average kidney recipient their quality of life is significantly greater and longer. I can personally testify to that fact! More kidney transplants benefit patients and society as a whole - so what are we waiting for? We need to address the barriers to donation listed above with real determination.

TRANSPLANTS SAVE LIVES, MONEY and MISERY,

but only if families agree to donation

and clinicians discuss this isssue with them.