Anyone in the UK, of any age, can sign the Organ Donor Register, and give permission for their organs and tissue to be donated after death. How you register your wishes depends on where you live: in Northern Ireland and England, one must sign a register to opt in, while Wales currently operates an opt-out system, and Scotland plans to follow suit.
In light of this, a rival system called Organ Tree was recently launched, which has raised significant concerns among transplant experts.
Organ Tree works very differently from the standard register. When you join Organ Tree, you pay a small registration fee – it is free to sign the organ register – and can join as a donor or a recipient. If you join as a donor, and die in a way that allows you to become an organ donor, Organ Tree claims that your organs will be offered to other members registered as recipients. These recipients are expected to compensate a donor’s chosen beneficiary by an agreed amount.
Organ Tree is essentially an organ donation club, designed to benefit its members.
This approach immediately throws up two controversial ethical and legal issues: directed donation, and payment for donation.
Following a case in 1998, when a donor’s relatives requested that his organs were only given to white recipients, there has been a general ban on deceased donors choosing their recipients in the UK. Only in a very narrow range of circumstances can exceptions to this be considered, for instance, when someone dies with a family member on the waiting list.
It seems unlikely that the service offered by Organ Tree would fall into this permitted category. It is a fundamental aspect of deceased donation that organs are allocated according to clinical need, which accords with broader NHS principles about access to treatment. So it is difficult to see how a private organ donation club could hope to match their donors with their recipients, given that the organ retrieval and transplantation would be undertaken within the NHS.
Organ Tree’s website states that “a nominated beneficiary is eligible to be reimbursed to help offset funeral costs”. The recipient of the donated organs is expected to make this payment.
Although it has been suggested that the NHS meeting funeral costs might be ethically acceptable, this is not something that currently occurs. And it is especially not something that organ recipients are expected, or permitted, to do.
In addition, the Human Tissue Authority, which regulates the use of human tissues and organs, cautions that anyone attempting to enter into a financial arrangement regarding organ donation is likely to be breaking the law. Although the payment may be described by Organ Tree as “reimbursement”, the donor’s family would pay funeral costs if donation did not go ahead, so it is challenging to view it as anything other than incentive.
A two-tier system
The transplantation system in the UK is a remarkable communal response to medical need, where the selfless generosity of individuals saves or extends the lives of patients who are often in desperate situations. It is not a perfect system, and does not meet the needs of everyone, but the introduction of additional private systems seems unlikely to improve anything.
Some have suggested that systems which prioritise registered donors might offer advantages, by giving people an additional reason to become a donor. Such a system exists in Israel and, until recently, an organisation called LifeSharers ran a similar service in the US. In the UK, however, these would fall foul of NHS principles by allocating resources according to factors other than clinical need.
Organ Tree is different again, however. Rather than accessing the club by displaying a willingness to help others – which anyone can do – to receive a transplant through Organ Tree one must be able to pay the donor’s family. So recipients could buy preferential access to transplantation, which runs completely contrary to the ethos that underpins organ donation in the UK.
Is it worth it?
If organisations like Organ Tree resulted in many more people agreeing to donate, then some compromise of ethos may be justifiable: the organ donation system is after all intended to save lives, not just to promote selfless giving. But it seems more likely, given the current legal and policy restrictions, that this kind of transplant club will just confuse the situation, and lead to some people not joining the official organ register.
Attempts to increase the number of organ donors should be encouraged only if they are likely to be effective, and are ethically and legally acceptable. Given the issues described above, and advice issued by the Human Tissue Authority, clubs such as Organ Tree are unlikely to meet any of these criteria.
If you would like to become an organ donor, the best advice remains as it has for some time: join the real organ register, and discuss your wishes with your family.