Emergency nurses expected to help ensure organ donation opt-out succeeds

NHS Blood and Transplant will need the help of front-line staff after change to legislation

NHS Blood and Transplant will need the help of front-line staff after change to legislation

Picture: Phillip Carpenter

The government in England has set out its plan for an opt-out system for organ donation.

If parliament votes in favour of the legislation in the autumn, the plan will come into force in 2020.

Under the new rules, children, individuals who lack mental capacity to understand the changes and people who have not lived in England for at least 12 months before their deaths will be excluded.

The move follows the introduction of similar legislation in Wales, in 2015. Scotland has also promised to introduce an opt-out law and Northern Ireland has expressed an interest.

NHS Blood and Transplant interim director, organ donation and transplantation, Anthony Clarkson says nurses in emergency and intensive care settings have a crucial role to play in ensuring the change increases the number of organ donors.

Donation is only possible in about 1% of deaths. Last year, NHS staff referred 99% of potential donors through brain death, and 89% through circulatory death, to NHS Blood and Transplant specialist nurses.

Potential donors

Mr Clarkson says NHS Blood and Transplant will need the help of front-line staff even more after the change, when everyone becoms a potential donor.


transplants took place last year

(NHS Blood and Transplant 2017-18)

‘We rely on nurses to refer potential donors to us for assessment. Without them, organ donation could never occur and more lives would be lost.

‘We do have excellent referral rates, but moving to an op-out system means we will need nurses to help us get to 100%.

‘There are circumstances where people cannot proceed to donate because of age, medical conditions, infections or other issues.

‘But I would encourage all nurses to check their hospital policy for donation and refer any patient who meets the set criteria, thereby allowing our organ donation teams to determine suitability to donate,’ he adds.

Discussing decisions

Mr Clarkson says that, by pushing ahead with the changes, the government has already had an effect on organ donation because more people are talking about it.

‘Nurses need to be prepared to have these conversations wherever they work.

‘We need people to discuss their decision with their families and make clear that they would like to be organ donors.

‘Our research proves that has biggest impact upon family support.’

Under the government’s plans families will still be able to block organ donation.

Mandatory training

Royal College of Nursing emergency care association member Justin Walford says that, as a result of the change in legislation, more front-line nurses may need to broach the issue of organ donation at the end of people’s lives.

‘We try not to have these discussions in emergency departments – they are best had in intensive care by the specialist organ donation team.


extra transplants may take place if the opt-out rule is introduced

‘But sometimes that isn’t possible and we have to be prepared,’ he says.

He would like to see nurses, certainly those in an emergency and intensive care settings, given mandatory training in communicating about organ donation, with a strong element of role-playing incorporated.

‘If you have had some experience and training it is obviously easier.

‘A good way to start the conversation is to talk about the tissues that can be taken and then move on to the organs.

‘I would like to see the training become mandatory so all nurses are prepared for these conversations.’

Extra transplants

There is uncertainty about the effect of the change in legislation on the number of organ donations.

Last year there were 1,355 organ donors in England, leading to 3,356 transplants, but about 400 people died on the transplant waiting list.

The government estimates that the new system could generate 700 extra transplants each year.

Research shows that 82% of people support organ donation, but only 37% have recorded their wishes on the NHS organ donor register.

The plans were set out after a consultation earlier this year received an unprecedented 17,000 responses. A large majority were in favour of the changes.

Preference to donate

But a study published after the government unveiled its plans has suggested they may not work as intended.


people responded to the government consultation on organ donation

(Department of Health and Social Care 2018)

The research by Queen Mary University London (2018) presented participants with a fictional scenario and asked them to judge the likelihood that the individual concerned wanted to donate organs.

A donor’s preference to donate was deemed to be greater when they had chosen to opt in than when they were presumed to consent to donation under an opt-out system.

Lead researcher Dr Magda Osman says: ‘Making a free choice indicates what your preference is. If you don’t actively choose, then it isn’t clear if you really wanted to donate.

‘This matters because, in the event of death, your relatives have to decide what to do.’

The child who inspired the change in the law

Max Johnson
Max Johnson. Picture: Mirrorpix

The new opt-out law has been dubbed ‘Max’s Law’ after the boy who inspired ministers to push for change.

Max Johnson had a heart transplant last year aged nine after a high-profile campaign by the Mirror newspaper highlighted his agonising wait.

He needed a transplant because he had an enlarged heart.

Max, from Cheshire, eventually had the life-saving surgery in August at the Freeman Hospital in Newcastle. The donor was a nine-year-old girl who had died in a car accident.

Prime Minister Theresa May said the plight convinced her to act, calling him a ‘very brave young man’.

‘Our NHS is world-class yet people are still dying every day because of the shortage of organ donors.

‘That’s why we want to increase the donation rate and make it easier for everyone to record their wishes whatever their preference.’


Angela Ditchfield: the specialist nurse for organ donation

Angela Ditchfield

A specialist nurse for organ donation in the North West, one of 12 regional teams covering England and Wales, Angela Ditchfield is on call to accept referrals from doctors and nurses in emergency departments and intensive care settings.

She also provides training to staff about organ donation.

‘We help staff identify which patients are suitable for organ donation. We will be invited to speak to the family once a clinical decision has been made and the patient is at the end of life.

‘We would normally be the ones who discuss the issue of organ donation first with the patient and their family.

‘Sometimes this isn’t possible, we may be an hour or two away and then the staff with the patient have that discussion.

‘We then organise and facilitate the next steps. That will involve blood tests so we can identify good matches for the transplants and organising the specialist retrieval teams to come in and perform the operation.

‘We then prepare the body for the family afterwards. If families want to we can help keep the donors and recipients in touch. It depends on what they both want.

‘We will support families throughout and will write to them to let them know how the recipients are doing after their transplant.’


Nick Evans is a freelance health writer


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