Organ Transplantation Flashcards

1
Q

Why do we need law to regulate OT?

A

To regulate training and fitness to practice
Law of negligence
Private health care
Consent

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2
Q

1st Stage of Law

A

1952 Corneal Grafting Act - using cornea of a dead person.

Was no prior existing law/duties relating to dead bodies. Created law to keep up/facilitate use of technology

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3
Q

Law on dead bodies prior to Acts

A

Bury or burn them, because were a health hazard

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4
Q

2nd Stage of law

A

Human Tissue Act 1961 - general rules relating to removing organs from DEAD bodies

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5
Q

Churchill Clinic Scandal

A

Transplants were performed for wealthy patients who were paying large amounts of money. Get kidneys from developing countries and bring them to England, pay them little and send them back.
Q’s surrounding consent to kidney removal, and medical ethics - no post op care, paid little - exploitation

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6
Q

Alder Hey & Bristol Royal Infirmary Scandal

A

2 hospitals found to be removing the organs of children who had died in hospital and storing without consent of parents.
Crisis for NHS: 1) undermined assumption of patients that docs acting in best interest and could be trusted. 2) cast bad light in removal of organs - lead to public turning away from transplant programme

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7
Q

Human Tissue Act 2004 - 3rd Stage

A

Removal, use and storage of human tissue
Live & dead donors
Criminalises some activities
Est human tissue authority & code of conduct

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8
Q

What types of interest does regulation try to balance?

A

Protection of life, autonomy, exploitation, patient safety, what happens to the body after death, efficient use of med resources, relatives thoughts & cultures

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9
Q

Difference between brain death and donation after a cardiac death

A

Brain death → irreversible loss of all brain function, organs removed while heart is kept beating artificially.
Donation after cardiac death → irreversible loss of circulatory function, organs removed as soon as possible (75 secs - 5 mins)

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10
Q

Is there ownership of the corpse?

A

No ownership of corpse/power to determine fate of one’s body after death. No property rights.

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11
Q

Moore v Regents of uni of California (persuasive)

A

Held: M had no property rights over cell-line (worth £15bn) developed from cells removed from his spleen, following removal for treatment of leukaemia.

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12
Q

Dobson v Tyneside HA

A

Family of deceases sought return of the brain to support negligence claim against HA arising from deceased’s death.
Held: no ownership of the brain. Executors have limited right to possess corpse for purpose of burial/cremation. Prop rights in body parts could arise where work has been done on it. Removal of brain lawful for autopsy - hospital had right to dispose of it.
[Become prop of person who had applied skill]

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13
Q

R v Kelly

A

Hospital technician charged with theft after supply body parts to artist for incorporation in artistic works. Held: parts of a corpse are capable of being property if they have acquired diff attributes by the application of skill, such as dissection or preservation techniques for exhibition or teaching purposes.
No prop in the unmodified property. To deny body as property - suggests no one can ‘steal’ it - body does have some value which can be misappropriated

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14
Q

Death - difference between heart beating and non-heart beating

A

Brain dead - heart beating - ventilated

Cardio vascular death - non-ventilated - non-heart beating

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15
Q

Evans v Amicus Healthcare

A

Mr E didn’t want to be father, said if you have donated sperm/eggs, you retain control over them. You consent to use. Idea of consent and control at odds with ‘owning’ body

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16
Q

Yearworth v Bristol NHS Trust

A

Frozen sperm, freezer defrosted. Sperm/eggs donated couldn’t be used. Claim in negligence as freezer was faulty, should have been recognised. Loss of chance to be fathers. Were successful. Even though body isn’t property, was a product - been damages so could get compensation

17
Q

Re A

A

Brain death is death for legal purposes
Parents (accused of assault on infant child) sought declaration that the ventilator could not be switched off. Docs argued his brain was stem dead - therefore he was dead. CA held: brain death is death for legal purposes

18
Q

HTA 2004 - ‘appropriate consent’

A

Need ‘appropriate consent’ and materials need to be approved for a ‘schedule 1 purpose’.
Legal to remove, store and use relevant material from a live and dead donor.
→ Relevant material is all except gametes, embryos created OUTSIDE the body, incl hair and nails from living person

19
Q

HTA 2004 - consent

A

Must be for material to be stored/used for a particular purpose; positive consent required - not just failure to object → voluntary, informed, mental capacity
Living donor - competent adult for consent
Dead donor - donor before death, applicable representation of from person in closest qualifying relationship

20
Q

S27 HTA 2004

A

Qualifying consent, just need 1 person to say yes to do transplant

21
Q

Fail to obtain appropriate consent defence

A

Defence of reasonable belief

22
Q

Should we treat the dead? → Heart beating donors

A

Fears about diagnosis of death
Feelings of relatives
Ethical issues - pro-longing life

23
Q

Elective ventilation

A

Practice for purpose of transplant than therapy
Illegal in UK
Where you treat someone as a potential donor when alive, without consent (too sick) to facilitate harvesting organs.
Not in P’s best interest?
Unlawful → battery?

24
Q

Should we treat dead? → Non-heart beating donors

A

Heart has stopped, death diagnosed on cardio-respiratory criteria
Risk of rapid decay
Cold perfusion of organs to maintain viability
Lack of legal clarity around how a P close to death can be treated differently to facilitate donation

NHBD requires consideration of donation prior to death. Unconscious patient ‘treated in best interest’ - Bland
Best interest not confined to what is immediately clinically beneficial, informed by patients values - MCA 05 s4

25
Q

Opt in system

A

Currently in place, to be replaced by opt-out

Still reluctance to remove organs without family agreement

26
Q

Ways of securing a supply of organs

A
  1. Opt out - presumed consent
  2. Commercial market for organs - could be regulated to NHS
  3. Mandated choice
  4. Mandated donation
27
Q

Typical case of live donor transplant

A

Transplant of kidney between members of the same family

Problem → rejection

28
Q

Live donors - consent

A

Can only be non-vital organs transplanted

Cannot consent to substantial bodily injury - except for low risk donations (public policy)

29
Q

Brown and others

A

D’s engaged in sadomasochistic acts resulting in ABH and GBH - held could not be consented to in sexual acts of pleasure and pain

30
Q

Live donor donations, what you have to compare

A

1) Degree of risk
2) Informed consent
3) General interest in saving life
4) Chances of success in particular case

31
Q

Problems of consent - Sidaway v Bethlem Royal Hospital

A

Bolam applies but should inform patients of material risks

32
Q

Consent - Montgomery v Lanarkshire Health Board

A

Overruled Sidaway - rejected reasonable doctor test and established a duty of care to warn of the material risks

33
Q

Re W

A

Application made allowing hospitals to treat a girl aged 16 suffering from anorexia nervosa against her wishes. Held: allowed, anorexia destroyed ability to make informed choice - overriden for best interest
O16 consent doubted for organ donation

34
Q

Re F

A

Woman lacked mental capacity, held lawful to operate without her consent - in best interest

35
Q

HTA 04 restrictions on transplants for living

A

S33

36
Q

HTA 04 ban on commercialisation

A

S32 - prohibited - desire to stamp out market for organs

37
Q

Statistics May 2019 for OT

A

Over 6000 people waiting for a transplant

Only 1574 deceased donors in previous year, 200 more since 2016