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UK bioethics council considers organ donation
Unmet demand for organs, tissues prompts research
The Nuffield Council on Bioethics in London has set up what that organization terms a working party to study the issue of whether the UK can ethically increase organ or tissue donation by offering incentives.
The council is looking at associated issues with whole organs, blood, skin, corneas, bone, sperm, eggs and embryos, as well as clinical trials designed to test the safety of new medications in humans for the first time.
"There isn't one sort of obvious event that's been a trigger [for the research]," Katharine Wright, assistant director of the council and the leader of this particular project, tells Medical Ethics Advisor. "I think it's been more of a growing awareness that there's a real demand for bodily material in the UK and elsewhere. . . and demand massively exceeds supply. And the obvious response to that tends to be, what can we do to maximize supply? What we felt would be really helpful would be to take a step back and think about how we should respond to demand, say, are there ethical limits on what we should do in encouraging people [to donate]? And obviously, the questions there arise around if [organs or tissues are] won by paying people, should one do it, or are there ethical reasons for not doing that?"
Like many developed and wealthier countries, there is also the issue of "transplant tourism," i.e., British citizens in need of a transplant going to lesser-developed countries to find organs.
"It is known that it does go on, but [the evidence] tends to be very anecdotal," Wright says.
According to a release from the council, the current system of organ donation in the UK relies on people donating to help a loved one or society as a whole, i.e., as an expression of altruism. The council indicates that the National Health Service (NHS) "has been working to increase organ donation by improving transplant infrastructure and encouraging people to sign the organ donor register."
The council also notes that about 8,000 people are waiting for an organ transplant in the UK, and there is also a demand for "roughly 1,200 more egg donors and 500 more sperm donors. Scientists also need people to donate human tissue for research."
"We ourselves or one of our relatives may one day need donated organs or tissues, and most of us are likely at some point to use NHS medicines that have been tested on healthy volunteers or human tissue. Given this, perhaps donating parts of our bodies should be seen as a moral obligation for all of us," said Professor Dame Marilyn Strathern, chair of the working party and professor of social anthropology at Cambridge University, according to the news release.
The working party was convened in January. In addition to being led by Strathern, a wide range of expertise is represented via other members, including experts on organ transplantation, law, health psychology, tissue research, and ethics, among other specialties.
"The council as a whole identifies what it thinks is an important ethical issue, where it can make a difference," Wright tells MEA. "And I think making a difference is an important thing to emphasize, because we don't want to produce academic reports, or we don't want to duplicate other people's work; we want to find something where there's a real question, and where we can make useful policy recommendations."
Some incentive inequalities exist in UK
One of the things that interested the council in taking up this project, Wright says, is that in the UK, "there's a very strong tradition of altruism, with a sense that money somehow sort of muddies the waters, and that financial incentives aren't right."
And there are variances in how certain types of donations are incented vs. other types of donations in the UK, she explains.
"So, you have blood donation that's always being done altruistically; you have donation of organs after death, which is altruistic, and you have donations of organs during life, which would mainly be someone you know, although for the last couple of years, there have been a few examples of people giving an organ to a stranger, in the same way that they would give blood," Wright explains.
Individuals in the UK who are living organ donors can have their expenses reimbursed; for example, if they have to take time off from work, they will be reimbursed for that absence.
"It's not an incentive; it's simply making them not worse off," Wright says. "Now, there are contrasts, because if you're donating eggs or sperm, you can't have a financial incentive; you just have your expenses covered. But if you share your eggs and are undergoing IVF treatment, you can opt to share those eggs and have reduced price or even free treatment, which is obviously not money in hand, but it has significant financial value."
Wright also points out that it's always been the case in the UK that individuals who are "lending or giving over their bodies, as it were," to test new medicines have been paid.
"It's interesting to explore if that's different, why is it different," she says. "One of the points in our consultation paper is: Do people feel that difference can be justified? And that's how regulation develops. Or, is it possible we can identify an ethical basis of why actually money in that case is appropriate, and money in other cases isn't?"
The working party's findings, including policy recommendations, will be published in the autumn of 2011. In the meantime, the Nuffield Council on Bioethics is accepting public comment on its consultation paper through July 13. That paper can be accessed at www.nuffieldbioethics.org/bodies.
Katherine Wright, Assistant Director of the Nuffield Council on Bioethics, London, UK. www.nuffieldbioethics.org.