Potential organ donors should be identified as early as possible
Plans to improve the identification of potential organ donors and consent rates in order to address the shortage of organs for transplant have been set out, in latest guidance from NICE.
Around 10,000 people are currently on waiting lists for transplantation in the UK, and 1,000 people will die every year while waiting for an organ to become available.
This comes despite 18 million people being currently on the NHS Organ Donation Register. Reasons for low donation rates include not knowing a person's wishes, and those close to them not consenting to organ donation.
NICE's first guideline on organ donation seeks to address the shortage of organs for transplantation by improving the rate of potential donors identified.
It also aims to increase organs available by improving consent rates from people close to patients that are potential donors, and who have been declared dead after the brainstem has stopped functioning, or whose death has been confirmed after cardiac death.
The guideline recommends that organ donation should be considered as a usual part of end-life-care planning. Furthermore, each hospital should have systems in place, consistent with the recommendations, to identify potential donors and manage the process for consent.
Patients who are potentially suitable donors should be identified as early as possible based on two possible criteria.
The first is defined clinical trigger factors, which indicate a high likelihood of brainstem death, in patients who have had a catastrophic brain injury. The second is the intention to withdraw life-sustaining treatment in patients with a life-threatening or limiting condition which will, or is expected to, result in circulatory death.
If the patient is in circumstances where they are able to make their own decisions, the healthcare team should seek their views on organ donation and consent.
If the patient is close to death and unable to make their own decisions on consent, the healthcare team should determine whether taking steps before death to help organ donation would be in the patient's best interests.
This can be done by considering the patient's known wishes and feelings, asking people close to the patient what their thoughts and wishes are, checking whether the patient is on the organ register, and whether they left an advance statement.
Those close to the patient should be approached in a setting suitable for private and compassionate discussion, and they should be given sufficient time to consider the information.
Dr Fergus Macbeth, Director of the Centre for Clinical Practice Director at NICE said: "Organ donation can be a sensitive subject, particularly if decisions are made at a time of bereavement.
"It is, therefore, crucial that there is a clear guideline in place to support and assist healthcare professionals at this time. I am sure it will be helpful to all those involved in this important process."
Gary McVeigh, Professor of Cardiovascular Medicine at Queens University Belfast, and Chair of the Guideline Development Group, said: "Research suggests many people approve of organ donation but the reality is there is a great shortage of organs, and around 1,000 people die every year in the UK whilst waiting for a transplant.
"I hope this guideline will encourage more people to sign up to the NHS Organ Donor Register and, importantly, tell those close to them of their wishes and intentions.
Jane Nix from the Donor Family Network, and Patient/Lay member of the Guideline Development Group, added: "The Donor Family Network welcomes the publication of this guideline.
"More organ donors are so desperately needed by those on the waiting lists and I hope this guideline will help improve consent rates.
"For a lot of donor families, consenting to organ donation has become a positive decision at such a tragic time in their lives."
A range of support tools are available to put this guideline into practice, including a baseline assessment tool, a costing template, and a slide set.
12 December 2011