Edinburgh Napier University

  The crisis in the numbers of donated organs has featured strongly in the U. K.
literature highlighting the growing gap between those waiting for a transplant
currently 6,698 and the numbers of organs available for transplant in 2006
numbering 2,195 (UKT, 2006). To address this the new Human Tissue (Scotland)
Act 2006 and the Human Tissue Act 2004 (England and Wales) have sought to
increase the numbers of organs available for donation, whilst upholding the
principle of informed consent to the donation of one's organs contained within the
previous legislation. Critics of this "opt in" system however, suggest the adoption
of presumed consent legislation or "opt out" as is the case in much of Europe.
Little research exists that explores impact on the health care professionals (HCPs),
the bereaved relatives, the health care system and society overall of any change to
presumed consent legislation. The aim of this study was to explore the views and
experiences of the HCPs who utilise this legislation in their practice, identifying
implications for these professionals, the bereaved relatives and the health care
system of using presumed consent legislation.
Methods
Adopting a phenomenological approach this study utilised the responses to an
initial quantitative survey using a questionnaire and combined this with qualitative
semi- structured interviews with HCPs who had experience of organ donation in
three European countries, Portugal, Norway and Belgium thus capturing the
"lived experiences" of the professionals who use this approach to organ donation.
A phenomenological framework first identified by Heidegger (1962) and
Gadamer (1976) was adopted to structure these interviews and analyse the data
developed from these sources.
Results and Discussion
The initial survey of HCPs in the three countries yielded 31 responses (10.6%
n=300) from Portugal, 47 (10.4% n=450) from Norway and 44 (35.7% n=123)
from Belgium, providing data relating to their experiences in applying presumed
consent legislation in organ donation, together with the benefits and challenges of
their particular organ donation system. Subsequently, semi-structured interviews
undertaken with 14 HCPs in Portugal, 13 HCPs in Norway and 15 HCPs in
Belgium demonstrated different approaches to the application of this legislation in
these three countries, as a result of varying infrastructures utilised to underpin
organ donation. Additionally, there was a dissonance between the requirements of
the legislation and the application of this by HCPs within the individual counties
resulting from ethical, cultural and professional practice considerations identified
by these professionals. Key amongst these considerations was the need to respect
the wishes of the donor and involve the bereaved relatives in the organ donation
decision-making process.
Conclusion
Implications exist for HCPs, bereaved relatives, NHS and society of any change to
presumed consent legislation from ethical, cultural and professional practice
perspectives. These require to be explored in more detail and addressed, should
this approach to organ donation be considered in the U. K.