A significant proportion of people in England and Wales would wish to donate their organs after death for the purpose of transplantation. This guideline recognises the complexities that arise owing to the majority of potential organ donors lacking the capacity to be directly involved in decision making at the time of their death. This guideline seeks to promote the identification and fulfilment of these wishes through:
more effective and expedient identification and referral of potential organ donors
a more informed, considered and timely approach to consent for donation that is based primarily on identifying the wishes of the individual whenever known and however recorded.
The General Medical Council (GMC) guidance 'Treatment and care towards the end of life: good practice in decision making' requires that consultant staff who have clinical responsibility for patients who are potential donors exercise a duty to consider organ donation as part of end-of-life care.
Although donation occurs after death, there are steps that healthcare professionals may need to take before the death of the patient if donation is to take place. This guidance covers such steps, and in the case of clinical triggers for referral, refers to actions that might take place even before the inevitability of death has been recognised. These actions may result in challenges and tensions for the healthcare teams but they can and indeed should be incorporated into local hospital policies in order to better promote donation as part of end-of-life care.
Organ donation for transplantation is a complex area and one to which conventional clinical research methods cannot be easily applied. Consequently, much of the evidence included in this guideline is of a qualitative nature and does not lend itself to conventional use of GRADE assessment. A modified version of the GRADE assessment tool has been used to assess study limitations, indirectness and inconsistency.
Recognising the ethical and legal context in this area, legal advice was sought and incorporated during the development of the guideline.