Memorandum by the Royal College of Nursing
EU-WIDE SHORTAGE
OF ORGANS
AVAILABLE FOR
TRANSPLANTATION
The UK appears to lag behind other countries
in terms of rates of organ donation. Countries such as Spain manage
donation rates of 35 per million population (pmp) compared to
the UK with only 12 pmp[3].
The UK has approximately 15 million people on
the organ donor register, indicating widespread public support
for organ donation. However, not all of those on the list suitable
to donate are identified at time of death. If they were the transplant
waiting list would be reduced significantly.
ORGANISATION OF
ORGAN DONOR
AND TRANSPLANTATION
SYSTEMS
Spain has introduced a system whereby all intensive
care units in Spanish hospitals have an identified organ donation
specialist whose role is to ensure transplantation is considered
in all suitable cases. UK Transplant have identified this as good
practice but in Spain such specialists are doctors however, in
the UK they are more likely to be nurses. This may have an impact
as the nurse's opinion may not hold the same weight in discussions
with colleagues and relatives as that of a doctor.
Another measure to increase organ donation rates
from registers donors could include a centrally held database
of all registered donors that can be accessed by all hospitals
allowing quick identification of potential donors. At present
the system relies on relatives making the donor's wishes known
or a donor card being found on their person. It is clear that
the current arrangements for organ donation are not working effectively
enough to deliver the number of organs required for transplants.
70% of the UK population have indicated that they would be willing
to donate their organs after death but only 20% carry donor cards[4].
RAISING PUBLIC
AWARENESS OF
ORGAN DONATION
The RCN has been promoting organ donation cards
and blood donation to its membership for a number of years. In
particular we promote the blood transfusion service at our annual
congress each year. We will continue to work with our members
working in organ donation and blood transfusion to raise awareness
within our membership.
ETHICAL ISSUES
RELATING TO
ORGAN DONATION
AND TRANSPLANTATION
Ethnic minorities continue to be over represented
on transplant waiting lists but under represented as donors. Partly
this is due to the differing blood and tissue types in ethnic
groups that makes cross group transplantation difficult. This
problem is exacerbated by the reluctance to release organs for
donation due to religious beliefs about death. More needs to be
done to increase cadaver and live donation from minority ethnic
groups including:
— Increased education amongst ethnic
minority groups.
— More use of peer support for those
on waiting lists and their families.
— Greater engagement with local communities
and their representatives on the importance of transplantation.
— Working with religious leaders to
dispel myths about transplantation.
THE NURSING
ROLE IN
ORGAN DONATION
If a "presumed consent" approach is
to be taken in the future nurses will need to be equipped with
the knowledge and support in dealing with relatives who may disagree
with the policy. There is already a need for transplantation to
have a greater role in nurse education and training. Most transplant
coordinators are nurses who come from intensive care backgrounds
but we would welcome a more structured educational approach for
transplant coordinators which meets agreed national standards.
This could be supported through professional organisations and
forums and their training and development programmes.
ORAL QUESTIONS
What do you identify as the issues relating to
organ donation and transplantation which are of greatest relevance
to the RCNs membership? Please would you describe the extent to
which the RCN has sought to promote excellence and to shape health
policies in relation to organ donation?
There are a number of issues relating to organ
donation and transplantation which are important to the RCN membership.
Nurses work closely with patients and their families and are very
often the members of the healthcare team who would broach the
subject of organ donation with distressed family members. Nurses
also work in a variety of settings where donor organs may be in
short supply and are a valuable resource. Therefore, RCN members
are acutely aware of the importance of promoting and raising awareness
of organ donation. Our members debated the issue of organ donation
and an "opt out" system at our annual congress in 2000
and at this stage adopted a position opposed to an "opt out"
system. However, at our annual congress this year we will again
be debating the issue where members will have an opportunity to
re-instate our existing position or push to change our position.
Following congress the Royal College of Nursing will have a programme
of work to promote discussions raised at congress to ensure our
members views are adequately reflected in forthcoming policy debates.
What exchanges of information has the RCN had
on issues relating to organ donation with professional colleagues
in other EU member states? To what extent is your professional
group supported and facilitated in making cross European connections
to share good practice and research?
The Royal College of Nursing has forged a number
of connections with European organisations such as the International
Confederation of Nursing (ICN) and the European Federation of
Nursing Associations (EFN) where our General Secretary, Dr Peter
Carter, sits on the Executive Committee. These healthcare coalitions
enable the RCN to share examples of professional best practice
with healthcare colleagues and associations across the EU and
discuss and debate policy which will impact on healthcare internationally.
The RCN also participates in a number of European nursing and
international forums such as the Royal Colleges International
Forum and the Nursing and Midwifery Council European Forum in
addition we also attend and contribute to policy debates through
the European Public Health Alliance where we ensure that our member's
views are reflected and represented at an EU level.
In what way is the RCN taking steps to consult
its membership on the issue of presumed consent? How essential
would the support of the nursing community be to the effective
implementation of such a system?
At this year's RCN annual congress members have
tabled a resolution which will generate a discussion about presumed
consent. Following the resolutions discussion RCN Council will
look at the debate; facilitate discussion with the relevant forums,
networks and communities of practice with professional interests
in organ donation and transplantation. Following these actions
the RCN will adopt a formal policy on the issue of presumed consent
and prepare work streams to ensure our members views are adequately
reflected in all policy discussions.
As indicated earlier in this response nurses
do work closely with donor's families who can often be very distressed,
and they are often the first people to broach the subject of organ
donation. Similarly nurses working as transplant co-ordinators
and in emergency care will have an important role to play in any
organ donation system. It will be important to have support of
the whole healthcare team in any decision to implement a new system
of organ donation no matter what that system may look like.
March 2008
3 UK transplant statistics Back
4
Payne D (1994) Donation or Direct Debit? Back
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