Organ donation, Past, Present and FutureBobbie FarsidesProfessor of Clinical and Biomedical EthicsBrighton and Sussex Medical School

Declaration of Interests

Member of the Department of Health Taskforce on Organ Donation and and Specialist Advisor to House of Lords European Affairs Sub-committee currently investigating organ donation issues

Views expressed today are my own unless otherwise stated

The significance of transplantation

The ancient dream of successful organ transplantation was finally realised 50 years ago, on December 23, 1954, at the Peter Brent Brigham Hospital in Boston. Over the subsequent half century, the separate disciplines of clinical transplantation and transplant immunology have made remarkable progress. The story of the convergent evolution of these two fields represents one of modern medicine’s most important advances.

Doyle, Lechler and Turka Journal of the American Society of Nephrology 15

Pp 2965-2971, 2004

Why buy into organ donation?

Life saving

Life enhancing

Cost effective

Emotively powerful

Ethical interest in organ donation

Early focus on the recipient

Involvement in research -

Refusal of treatment – ordinary extraordinary means distinction

Allocation of scarce resources

Shift of emphasis to the donor Altruism – influence of Richard

Titmuss’s The Gift Relationship (1970)

Criteria of death - brain stem death

Advance statements

Consent

Cultural issues

Definitions and rituals around death

Evolving models of communication

Communitarianism versus individualism

Body part scandals

A philosophical battleground?

Consequentialists versus Deontologists

The meaning of best interests

Current issues

What do we do in the face of scarcity – a resource allocation issue?

Opting inMandated choiceRequired requestOpting outLive donationUnrelated live donationMarketSurvival lottery

How do we distribute the available benefits?

Efficiency

Fairness

Blame and responsibility

Reciprocity

What can we do?

This is a practical and empirical question which formed a large part of the work of the Taskforce

What ought we to do?

Requires a wider debate

What are we entitled to do in order to increase and fairly distribute the benefits associated with organ donation?

What can we require of others in order to secure these benefits?

The others

Potential donors

Families

Health Care professionals

Communities

Future

Round full circle to the age of pioneers and new frontiers

Major challenge for health care professionals and citizens

The age of looking forward and hopefully working together