Heartbeat March 2020

Organ and tissue donation law
is changing
CORPORATE AND GENERAL
NEWS
12
This month, guest writer, Dr
Niroshini Karunasekara gives us an
insight into the upcoming changes
in the law around organ and tissue
donation.
In what is shaping up to be an
unprecedented year for our NHS,
there is a concern that the imminent
introduction of the donor opt-out system
in England may be overshadowed.
The Organ Donation Act 2019 was
passed by Parliament resulting in the
planned implementation of an opt-out
system. The change in the legislation
applies to both organ and tissue
donation. In real terms, it means that
all patients will be considered to have
consented to donation unless otherwise
stated.
When discussing this topic, it is
important to distinguish between organ
donation and tissue donation. Organ
donation has strict criteria regarding
who is eligible to donate and deals
with organs such as lungs, heart, liver,
kidneys, pancreas and small bowel.
Tissue donation, on the other hand,
includes heart valves, corneas, skin, bone
and tendons and almost everyone is
considered suitable.
Although incorporated within the
act, the subject of tissue donation
will still need to be broached by
medical professionals for the patient’s
information to be passed onto the
National Referral Centre (NRC).
According to NRC data, tissue donation
is a huge area that is still overlooked
nationally. A reluctance to approach
families near or after death means that
many potential donors are missed, and
tissues are not utilised.
Unlike with organ donation, patients
do not need to die in an emergency
department or intensive care unit to
donate tissue after death. Crucially, a
donation must take place within 24 - 48
hours of death. This means introducing
the topic early to a patient’s family is
vital. This will help to maximise the
number of tissue donations in the UK.
In 2011, NICE published guidelines
aimed at improving donor identification
and consent rates. Not only does this
document recommend that all potential
donors should be identified as early as
possible, but also that donation should
be considered as a usual part of end-oflife
care.
20 May 2020 is the date the organ and tissue donation law in the UK changes to opt-out
We conducted a quality improvement project
within our Trust that was designed to assess
our compliance with these expected standards
in post-bereavement care. Specifically, we
looked at whether we are providing the
next of kin with information regarding tissue
donation.
Information was collected from the
bereavement book on each ward within the
Trust, as well as both emergency departments
from September 2018 to September 2019.
We found that of the 586 entries assessed,
only 6 entries (1 per cent) stated that tissue
donation had been discussed with the next of
kin. This discussion is vital to gain consent for
the data to be passed onto the NRC allowing
them to contact families. Common reasons
why this may not be happening on the wards
At SWBH these results have been presented
at local meetings and several strategies
have been initiated to raise awareness of
tissue donation before the implementation
of the new law. These include:
• A series of educational sessions
which have been delivered to
various groups of healthcare
professionals including doctors,
ward staff and emergency
department staff
• A teaching programme for all
professional development nurses
within the Trust so that they can
disseminate information and
include; a lack of awareness about tissue
donation, apprehension of broaching
the subject, and, common cultural or
religious misconceptions.
These results reflect a similar picture
across the UK. It is clear that without
staff engagement, the Organ Donation
Act 2019 will not be as effective as
perhaps expected or hoped with regards
to tissue donation. As 20 May 2020,
the date for the new legislation rapidly
approaches, staff must be aware of
these changes and also educated and
trained to identify potential donors,
provide information to their next of
kin in a sensitive way, and refer to the
appropriate donation lead for their area.
continually update the nurses on
the wards
• Assessing the feasibility of adding
a mandatory section onto the
patient’s electronic records to
address organ and tissue donation.
These strategies are in keeping with the
principles and recommendations set out
by The Organ Donation Taskforce, the UK
Donation Ethics Committee and GMC
guidelines.
If you have any questions or
queries, please feel free to email
n.karunasekara@nhs.net to find
out more.