WIREDGOV

This POSTnote describes the scale and nature of living donation in the UK, its regulatory framework and the ethical considerations around this highly regulated procedure. It also analyses challenges within living organ donation, and the strategies implemented to address them.

Documents to download

• Living organ donation (385 KB, PDF)
  Download ‘Living organ donation’ report (385 KB, PDF)

Living organ donation refers to the transplant of an organ (such as a kidney or a lobe of liver) from a living donor. Kidneys are the most donated organ, accounting for 98% of living organ donations in 2019/20. As of March 2020, 4,960 patients were waiting for a kidney transplant. The average waiting time for a deceased donation was 2.5-3 years. Living organ donation is a highly regulated procedure. It offers better patient outcomes and a more cost-effective approach than deceased organ donation or alternative therapies but carries with it potential risks for the donors. These are minimised through rigorous health and psychological evaluations, and extensive donor aftercare. While there is a 1 in 3,000 risk of death for living kidney donors, living kidney transplants are not associated with any excess donor mortality, kidney failure or other disease. It is widely accepted that the risks are outweighed by the benefits to the recipient and to wider society (through reduced waiting lists and improved population health).

The new 10-year strategy for increasing living organ donation and transplantation is due to be published by NHS Blood and Transplant in Spring 2021.

Key Points

• The number of living organ donors in the UK has trebled over the last 20 years and is currently stable at around 1,000 doors per year. This accounted for 35% of overall transplant activity in 2019.
• Living donor kidney transplants are the most cost-effective treatment for kidney failure on the NHS, with the potential to save £25,800 per year when compared to dialysis.
• Transplants performed in the UK from living donors must comply with the requirements of the Human Tissue Act 2004 for England, Wales and Northern Ireland, and Human Tissue (Scotland) Act 2006.
• Before becoming a donor, individuals must first undergo multiple rigorous evaluations to confirm they are suitable for donation. These include health and psychological tests, together with motivation and consent assessments.
• The Human Tissue Authority is responsible for assessing all applications for living organ donation. To be granted approval, the donor must give consent freely and there must be no reward attached to the donation.
• There are 4 routes for living organ donation; 1) Direct donation to a known individual 2) Directed altruistic donation to a specific individual with no pre-existing relationship 3) Non-direct altruistic donation to a complete stranger 4) Paired/pooled donation where donor and recipient are incompatible so join a sharing scheme in which they are matched with other registered pairs to increase compatibility for the transplants.
• The UK Living Kidney Sharing Scheme is managed by NHS Blood & Transplant and uses algorithms to find matches for the recipients registered in the scheme. This runs every 3 months and is responsible for over 1,200 transplants since its inception in 2007.
• Social media may be used to find potential donors but this is rarely achieved. Matching sites are not permitted by the NHS due to ethical and regulatory concerns.
• Health inequalities are present within living organ donation as individuals from socio-economically deprived communities or minority ethnic groups are less likely to find a living organ donor. Barriers include lack of awareness and knowledge, reduced patient engagement and attitudinal barriers such as uncertainty around religious permeability and lack of trust in health professionals.
• A series of initiatives have been implemented to increase living organ donation in the UK. For example, the 2017 NHSBT campaign to target Black, Asian and Minority Ethnic communities included working with faith leaders and investing into the National Black, Asian and Minority Ethnic Transplant Alliance to address myths about living organ donations through trusted community organisations.
• The new 10-year strategy for Organ Donation and Transplantation is due to be published by NHS Blood and Transplant in Spring 2021.

Acknowledgements

POSTnotes are based on literature reviews and interviews with a range of stakeholders and are externally peer-reviewed. POST would like to thank interviewees and peer reviewers for kindly giving up their time during the preparation of this briefing, including:

Members of the POST Board*

Lisa Burnapp, NHS Blood and Transplant, British Transplantation Society*

Jessica Porter, Human Tissue Authority*

Jen Lumsdaine, NHS

Ofcom

Facebook

Paul Dooley, Matching Donors

Dr Adnan Sharif, University Hospitals Birmingham*

Dr Pippa Bailey, University of Bristol*

Dr Greg Moorlock, University of Warwick

Mr Videha Sharma, University of Manchester*

Dr Sara Machado, London School of Economics

Professor Gurch Randhawa, University of Bedfordshire*

Professor Neil Lunt, University of York

Professor Nithya Krishnan, University Hospitals Coventry and Warwickshire

Dr William Pettersson, University of Glasgow

Dr Daniel-Clement Osei-Bordom, University of Birmingham*

Katharine Wright, Nuffield Council of Bioethics*

Jan Shorrock, Give a Kidney*

*denotes people and organisations who acted as external reviewers of the briefing.