Transplantation

Question 1

Why do we need donated bodies

Answer 1

Transplantation
Scientific research
Medical education
The benefit to all of these is significant both to individuals and society more generally
The more donations the greater the benefit

Question 2

What Is the ethical issue

Answer 2

Is there is a resource available which can be put to good use often life saving should we not use it
If bodies or their parts are not donated they will be buried or burned - waste?

Question 3

Fundamental principle - making the most of the resources available is one consideration but not the only one

Answer 3

Consent - most of the U.K. Operates an opt in system apart from wales
Choose whether you want in or not
Next of kin decides finally if they agree with your decision
Donation will not go ahead without consent

Question 4

If donations brings so much good why worry about consent

Answer 4

Respect for autonomy - people expect to have control over bodily integrity while alive so why not whine dying or dead - coercion is often considered unacceptable esp in medical context
Respect for individuals values and beliefs - people may have religious objections to donations or believe their body needs to be kept intact
Concern for people still alive- it may distress relatives to know that organs or whole bodies are being donated and used without consent

Question 5

Alder hay scandal

Answer 5

Removal of organs from dead children without their parents consent.
Given consent for post mortems but had asked to keep organs together or not been told about removal
Resulted in public outcry, immensely distressing for parents, damages reputation of NHS and donation
Resulted in the HTA 2004

Question 6

Human tissue act 2004

Answer 6

Came into force 15th November 2004

Replaced the HTA 1961 and anatomy act 1984 -and human organ act 1989

Question 7

HTA make a fundamental principe

Answer 7

Consent

Question 8

What is HTA concerned with

Answer 8

Deals with the removal, storage and use of human bodies, parts and organs

Question 9

What are the 3 parts to the HTa

Answer 9

Part 1 - consent and organ transplantation
Part 2- human tissue authority
Part 3- misc

Question 10

What is part 1 S2

Answer 10

Appropriate consent - children

Question 11

What does part 1s2 concern

Answer 11

Children and
Live organ donation
Children who are competent can give consent
Competent = gillick competent
If the child is not competent then someone with parental responsibility can give consent but has to be in their best interests
This can become contentious
Deceased organ donation
Children who are competent can give consent: advanced declaration for their organs to be used for transplantation
If the child is nor competent then someone with parental responsibility can give consent

Question 12

Part 1 s3 concerns

Answer 12

Appropriate consent adult 
Live organ donation 
Adults must give consent 
Deceased organ donation
Adults can give prior consent: advanced declaration, for their organs to be used for transplantation

Question 13

What happens according to P1s3 if there is no advanced declaration

Answer 13

Consent can be obtained from a nominated person to make decisions after their death
If the person didn’t nominate a named representative - next Of kin

Question 14

HtA part 2

Answer 14

Sets up the human tissue authority

Question 15

Part 2 human tissue authority 3 parts

Answer 15

1 remit - licensing
2 issues codes of practice
3 regulates the transplants between living persons and prohibits commercial dealing in human material

Question 16

HTA part 3 section 43

Answer 16

It is lawful for hospital authorities to take minimum sets or preserve organs of deceased persons whilst the appropriate consent to transplant is sought

Question 17

What is the most important part of the changes

Answer 17

Getting consent

Question 18

What should be an overriding factor

Answer 18

Competent person have given consent

But practice has always been to ask the next of kin, regardless of any advance declaration made by the donor

Question 19

Role of public opinion in transplantation should we worry what people think about organ donation, organ allocation, how bodies and their parts are used more generally after death

Answer 19

These are moral views and we all probably have views on them

Question 20

E.g. Organ allocation

Answer 20

Organs are scarce should be put to good use but what is good use 
Preventing deaths
Providing good QOL
Providing food quantity of life 
Providing equal access to treatment 
Prioritising certain people - children 
Research

Question 21

Who’s views should count

Answer 21

Balance all views as they are all important

Question 22

Why do we need or balance all views

Answer 22

Doctors and scientists know about tissue typing and likely risks and benefits
Bioethicists know about key ethical principles and what they require
The public may be less likely to donate if they find the donation system to be objectionable