October 2012 S B Chetwynd – Human Organ Use 1

The use of human organs and tissue for medical treatment

Dr Sue Chetwynd

Associate FellowWarwick University

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Session Outline• Overview• Morality of organ and tissue

donation• Legal position• Procurement of organs and tissue• Distribution of organs and tissue

Overview• Types of tissue use

• Organs and parts of organ – heart, lungs, liver, kidneys etc.• Gametes – sperm, oocytes• Other tissue – blood, bone marrow etc.

• Replaceable/irreplaceable• Purposes

• Life saving• Life enhancing• Life prolonging• Life creating

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Morality of donation of parts of body

• Does our body belong to us?• Is donation self-mutilation?• Is it acceptable, praiseworthy or a duty to donate?• Is there a moral difference between donating

replaceable and irreplaceable tissue?• Or donation for different purposes?• Is there a moral difference between donation and

sale?October 2012 S B Chetwynd – Human Organ Use 4

Human Tissue Act 2004Regulates removal, storage and use of human tissue Lists the purposes for which consent is required (the

Scheduled Purposes).Specifies who may give consent for the Scheduled Purposes.Creates a new offence of DNA theftMakes it lawful to take minimum steps to preserve the organs

of a deceased person for use in transplantation while steps are taken to determine the wishes of the deceased, or, in the absence of their known wishes, obtaining consent from someone in an appropriate relationship.

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Appropriate consent Adults• Living adult (aged 18 or over)

• consent must be explicit, given by the adult, and comply with the requirements of a valid consent.

• Deceased adult.• For anatomical examination or public display, only the explicit

consent in writing and witnessed of the deceased person prior to their death

• For other purposes – the consent of• The deceased before her death,• Her nominated representative(s),• Or someone in a ‘qualifying relationship with her immediately

before she died

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Appropriate consent Children

For a living child appropriate consent is • the consent of the child if he or she has given valid consent. • Without this, consent should be by someone with parental

responsibility for the child. When a child has died the following consents apply: 

• For removal, storage or use of body parts for public display or anatomical examination the consent of the child (witnessed and in writing) when alive is required.

• For other Scheduled Purposes • the consent of the child prior to death, if valid• Without this, then consent from someone with parental responsibility• If no such person, then someone in a qualifying relationship with the child

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Types of living organ donation

Directed donationTo a specified personPaired Pooled donation

Altruistic (non directed) donation

Note: Directed donation is not permissible in cadaveric donation

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Procurement of organs• People make decision for organs to be used after

death (opt in system)• Families make decision after death – includes required

request• State authorises use of organs unless donor (or family)

objects• Choice to opt in or opt out• Person donates live organ or tissue• Sale of organs

• Live• Cadaveric

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Opt in systems

• Values autonomy – as long as family cannot override decision

• Allows for religious and other objections • Inadequate supply for present needs• But need to check for record of donation

intention

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Family decision

• Difficult time to approach family• May enable them to feel something good

comes out of death• Enables families feelings to be valued• Families are source of information about the

deceased which may be useful• Recipients like to know family are happy with

decisionOctober 2012 S B Chetwynd – Human Organ Use 11

Opt out system

• May increase supply• Still allows for autonomy – again if not

overridden by family• Raises worries about

• State ownership of bodies• Trust between doctors and patients – Best

Interests• Definition of death

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Live donation

• Only possible for replaceable or surplus tissue (kidney perhaps a special case)

• Often involves near family• May be concerns about undue pressure• And proper appreciation of health risks

in case of kidney and oocytes

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Sale of organs and tissue• Usually discussed in context of live

organ or tissue donation• But could apply to cadaveric organs –

payment to donors estate• Assumed it will increase supply• Worries about exploitation,

commodification and fairness of distribution

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Distribution - organs and tissue• Directed donation only allowed in live cases in

UK• Why not generally?• Could we operate the same system with sale

of organs/tissue?• Allocation according to

• Need• Dessert• Previous benefit

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Other issues

• Identity issues• Determination of death• Compensation in kind?

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Conclusions• Present supply is inadequate• Not clear what changes might increase supply• People have strong feelings about their bodies and

those of relatives• Respect for autonomy• Altruism and gift giving are valued• Worries about exploitation and commodification• Determination of death

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