RCoA response to Introducing ‘opt-out’ consent for organ and tissue donation in England

The Royal College of Anaesthetists (RCOA) has provided a submission to the Department of Health and Social Care, in response to the consultation ‘Introducing ‘opt-out’ consent for organ and tissue donation in England’.  The submission does not argue a position regarding support or opposition to the proposal – or indeed the ethical issues that arise.  Instead, our response focusses on the demands on NHS staff, hospital capacity and the role of our membership in delivery of donation and transplant services.

Summary of recommendations in the RCoA response:

As part of the extended surgical team, anaesthetists plays a vital role in organ and tissue donations, and we were pleased to see the role of anaesthetists and the development of anaesthetic practice in this area noted by NHS Blood and Transplant (NHSBT), in its collaborative four nations’ strategy ‘Taking Organ Transplantation to 2020: A detailed strategy’.

The NHSBT strategy notes that outcomes after a transplant are not as good as they should be.  The RCoA is at the forefront of the development of perioperative medicine, which is about ensuring patients are cared for either side of surgery – to be fit for surgery and supported through recovery and aftercare.  In our perioperative medicine vision document, ‘The pathway to better surgical care’, a particular focus is placed on addressing high-risk patients and developing tailored pathways.

Notwithstanding the conclusions of the [consultation] Impact Assessment (IA), which indicate that there is insufficient evidence as to whether a move to an ‘opt-out’ system will increase donation consent rates, increasing the annual number and quality of organs transplanted is the objective of this policy intervention.  Therefore, any decision to proceed with the introduction of an ‘opt-out’ consent system must be coupled with a comprehensive projection of the impact of service capacity and workload.

We believe that the following considerations need to be assessed in advance of any move to a new ‘opt-out’ system:

  • What will be the service impact on anaesthetists and intensivists who provide organ support for brain dead donors and the post-operative care for transplanted patients?
  • What will be the impact on the capacity required for solid organ transplantation in terms of theatre time and for support services such as radiology and pathology?
  • Patients in need of an organ transplant are, by definition, at end stage disease, which is invariably complex.  These patients will require consultant input for preoperative and postoperative management, which will create an increase demand on consultant and support staff time.

You can view the full response here



09 March 2018