April 20, 2024

Inferior organs transplanted to solve shortage

Are patients being informed?

Faced with a shortage of kidneys, surgeons are resorting to transplanting cancerous kidneys into desperately ill patients. Body parts from the elderly and patients with a history of cancer or drug abuse are being used. In the UK, the use of high-risk donors has doubled in ten years: from 13% to 26% per cent of transplants.

Professor James Neuberger, medical director of NHS Blood and Transplant told the UK’s Daily Mail: “There is no doubt that if we had more donors, we could be a lot more selective about those used. In some cases this is completely safe but we're seeing organs from higher risk donors used in order to meet the growing need for transplantation.” But the alternative, he said, is death on a waiting list.

The problem is that potential donors are fatter and more diseased. Furthermore, the immunosuppressant drugs which patients take after surgery to reduce the chance of rejection increase the chance of the cancer recurring.

In an article in the British Journal of Urology International, a team from the University of Maryland described five transplanted kidneys with cancer masses. These were cut out before being transferred into the recipient. The researchers concluded that such donations “offer a minor, yet feasible, solution to the current organ shortage.”

Serious ethical issues are involved here. Are the patients aware of the risks that they are taking? Who should have the final say, the patient, or the doctor? Although all the patients in the American study were aware of the risk they were taking, the experience of a man in the UK shows that this is not always the case.

A 37-year-old chef, John Richardson, received a new heart, but died five days later without regaining consciousness. His wife was shocked to learn afterwards that the donor had hanged himself, was a smoker with several tattoos – creating a risk of hepatitis – and a cocaine user. It had taken 15 minutes to restart his heart when he was found. Furthermore, the heart had a hole in it and needed repair before transplant.

From the surgeon’s point of view, complete transparency might not always be in the patient’s interest. Time may be limited, the risk may be hard to assess and patients might be too choosy.

As one British surgeon told the BBC: “It is fair to say that whilst patient choice is championed in many other areas of healthcare, it's difficult to reconcile that patient choice with running an efficient transplant service.” ~ Practical Ethics, Dec 9; BBC, Dec 7; BBC, Nov 24; Daily Mail, Nov 25

Michael Cook
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informed consent
organ donation
transplant surgery