Willing to donate? Attitudes to deceased organ donation in different circumstances

Why we studied attitudes to organ donation

Organ donation is important, but opportunities for donation are limited. All UK deceased organ donations are from people who die in intensive care after illness or accident. This is because organ retrieval can currently only take place in what’s known as a ‘controlled’ setting, where donation is carefully planned and coordinated. Although these circumstances account for many organ donations in the UK, deaths of this kind are uncommon, meaning only a very small number of families will ever have the opportunity to consider organ donation.

There is currently no pathway in the UK to allow donation after a sudden, irreversible cardiac arrest outside hospital, even if this was the person’s wish. As a result, many potential opportunities for donation are lost.  

There are around 1500 deceased donors in the UK each year, while thousands of people wait on transplant lists. For example, more than 7000 patients are currently waiting for a kidney.

In countries such as France and Spain, organ donation following sudden out-of-hospital cardiac arrest is already established practice and has helped increase the number of organs available for transplantation. This study aims to understand public attitudes to donation after sudden cardiac arrest.

What people think about organ donation in different circumstances

Many bereaved relatives believe that the current situation needs to be addressed.  

We surveyed over 500 members of the public and asked them to answer a questionnaire involving three vignettes (short, realistic descriptions of hypothetical scenarios) and a series of closed and open questions about organ donation. The vignette scenarios covered:

• donation after brain death  

• donation after withdrawal of life support  

• donation after cardiac arrest out of hospital  

Most people thought donation after cardiac arrest out of hospital already happened in the UK, which might be one of the factors influencing its widespread acceptance. 

Participants were just as comfortable considering donation for a loved one in the context of sudden out of hospital cardiac arrest as they were after withdrawal of organ support  following brain death or organ failure; and most people said that they were keen to donate organs themselves.  

Normothermic regional perfusion

In France and Spain, a procedure called normothermic regional perfusion (NRP) is used to preserve abdominal organs after death. It involves putting a tube into the blood vessels at the top of the deceased person’s leg, keeping blood flowing to the kidneys and the liver mechanically. This helps to preserve the organs and gives loved ones more time to think about donation.

There have been ethical debates about the procedure, and although previous studies have shown that there is broad public acceptability of organ‐preserving technologies, it’s important that NRP is also acceptable to the public. 

We found that most people (71%) were comfortable with the idea, usually for altruistic reasons and because it potentially gives families more time to process a sudden loss. We suggest that a better understanding of public views is important to the ongoing discussions surrounding the procedure.

The future of organ donation

A pilot of this type of organ donation is happening at Cambridge University Hospital, and ongoing work is being done to understand how family members and clinicians feel about their experiences of this.