Talking Figures - International Donor Rates – 2007

Timing of Request for Organ Donation Crucial For Consent

Many more people would agree to donate the organs of a dead relative for t ransplant i f they were approached in the right way and given more time to think about it says a research study published online by the British Medical Journal.

 A recent audit of 341 deaths in intensive care units showed 41% of people refused when asked to donate their dead relative's organs. But other work has shown people can change their minds. In one study, 30% of relatives said they would not refuse if they were in thesame situation again, and only a few who gave consent later regretted it.

Dr. Duncan Young, from the John Radcliffe hospital in Oxford, and colleagues examined findings from20 studies on organdonation to find out what influenced relatives' decisions. Most of the studies werecarried out in the USA, where more work on the issue has been done and success rates tend to be higherthan in the UK.

"The two factors that had the largest effect on consent rates were the person making the request and thetiming of this conversation," they write in their paper. When a doctor or nurse made the organ donationrequest on their own, 53% of relatives gave permission. In one of the US studies, when the request was made by a trained transplant coordinator, the consent rate went up to 62%. But when doctor and transplant coordinator made the approach together, the rate rose to 72%.

Other significant factors were ensuring that the relatives fully understood what was meant by brain-stem death and how well they thought their relative had been cared for in the hospital. Timing is crucial, the researchers found. Family members who are asked for their permission at the moment of being told their relative is braindead are much more likely to refuse.

Travelling the World with Dr. Robin Eady

Meeting Dr. Robin Eady, 69, was a revelation – he is a renowned dermatologist who has done pathbreaking research in the field of Epidermolysis bullosa (EB). A national laboratory to diagnose this rare inherited skin disorder is named after him at St Thomas' Hospital, London. EB is a group of disorders that cause severe blistering of the skin – it is caused by mutations in genes that make the proteins which hold the outer layer of the skin, the epidermis, onto the inner layer of skin, the dermis. There are at least 10 genes involved in EB and the severity of the condition ranges from relatively mild blistering to severe blistering and skin loss which can result in early death from sepsis or other complications.

It seems entirely incidental that Dr. Eady is also the longest living person in the world with kidneyfailure – 47 years to be precise. He was diagnosed with end-stage renal failure at the age of 21 in 1962 when the side-effects from the treatment for the accompanying high blood pressure actually seemed worse than the disease itself. It wa s i n t h e e a r l y d a y s o f haemodialysis and only some centres in North Amer ica and Europe offered it and that too only for acute renal failure. He was, however, chosen by the pioneer Dr. Belding Scribner who devised the “Scribner shunt', t o b e p a r t o f t h e S e a t t l e haemodialysi s programme. After that there was no looking back for Dr. Eady even though it involved him moving to the USA and Canada before he could finally head back home to the UK to continue his dialysis. But none of this held him back - he went on to complete his medical studies and became a dermatologist. He was on dialysis for 24 years before he received hi s t ransplant . He t raveled around the world while on dialysis even though it required meticulous planning as dialysis schedules had to be adhered to. He has undergone dialysis in 30 centres in 15 countries. Maybe he was bitten by the travel bug early on in life because he was born not in the UK but in Cairo, Egypt ! He underwent a kidney transplant after receiving a kidney from a deceased donor in 1987.

Dr. Eady was in Chennai to deliver the Krishnan-Ang Endowment lecture organised by TANKER Foundation on 25th January 2010. His talk 'Trials, tribulations and triumphs – the adventures of a kidney patient' stressed the need for leading a disciplined life and having family support to conquer the disease. He also spoke about the importance of organ donation as his life was transformed after he received a kidney transplant. Dr. Eady has been involved in discussions with health officials in the UK about the feasibility of adopting the opt-out system for organ donation, where everybody would be assumed to be willing to donate organs unless they specifically stated otherwise. But, he said that there has been resistance  to this as the general opinion is that a person's organs should not become public property after death.