Research reveals public support for expanding organ donation after irreversible cardiac arrest

Researchers in Cambridge have found overwhelming public support for organ donation after irreversible cardiac arrest outside hospital – a form of donation not currently available in the UK.

Currently, all deceased organ donors in the UK are people who die in intensive care. This is because organ retrieval occurs only in 'controlled' settings, where donation can be carefully planned and coordinated, and there is more time to arrange the transplant team and call a recipient into hospital.

Although these circumstances account for many organ donations, deaths of this kind are uncommon, meaning only a very small number of families will ever have the opportunity to consider organ donation.

What did the research find?

A survey of more than 500 people revealed most were just as comfortable considering donation for a loved one after sudden and irreversible cardiac arrest out of hospital as they were in established donation scenarios following brain death or withdrawal of life-sustaining treatment.

The study, which was supported by NHS Blood and Transplant and part-funded by the NHS Blood and Transplant Charity, also revealed that 96% of respondents believed this kind of organ donation, which would involve more use of donor medicine and more use of organ preservation, was already part of standard practice in the UK.

Participants overwhelmingly indicated that they did not want organs to go unused. Many said they wanted to respect their loved one’s wishes, while others felt organ donation would provide comfort for the bereaved. Only a small minority opposed organ donation in any circumstances, most commonly because of personal or religious beliefs.

Organ donation following sudden out-of-hospital cardiac arrest is more commonly practiced in France and Spain, where it has helped more patients to receive life-saving transplants.

It involves preserving organs after an irreversible cardiac arrest has happened outside a hospital setting, using additional donor medicine and advanced perfusion techniques, helping create enough time to make transplantation possible for more patients.

The findings have now been published in the peer-reviewed journal 'Health Expectations' and can be found on the Wiley Online Library.

The findings come at a time when demand for donor organs continues to exceed supply. There are around 1,500 deceased organ donors in the UK each year, while thousands of people remain on transplant waiting lists. More than 7,000 patients are currently waiting for a kidney transplant alone.

The researchers hope the paper will encourage further discussion about how more people’s wish to become organ donors could be fulfilled.

The research was carried out by The Healthcare Improvement Studies Institute, (THIS Institute), at the University of Cambridge and Cambridge University Hospitals (CUH). It was supported by NHS Blood and Transplant, the Wellcome Trust, the National Institute for Health and Care Research (NIHR), and the Health Foundation, an independent charitable organisation working to build a healthier UK.

The study was led by Dr Zoë Fritz, an honorary CUH consultant and associate professor of medical ethics at The Healthcare Improvement Studies Institute as part of a wider study led by Mr Dominic Summers, CUH consultant transplant surgeon.

They were supported by Weiyi Tan, a student at the University of Cambridge School of Clinical Medicine, and Janet Cruse, member of a patient and public involvement group with lived experience of bereavement following out of hospital cardiac arrest where donation could not happen.

Statements

Dr Fritz said: "What stood out was the strength of feeling that organs which could potentially save lives should not go unused, especially if donation reflected the wishes of the person who had died. The willingness of so many people to engage so thoughtfully with the topic speaks to its importance and highlighted the need to understand public views as discussions about the future of organ donation continue."

Mr Summers added: "There is a shortage of organ donors in the UK, with up to three people dying each day while waiting for a transplant. This research confirms that a large majority of the UK public would like to help others after their death through this potential pathway for organ donation."

Dan Harvey, National Lead for Innovation and Research in Organ Donation at NHS Blood and Transplant, which provided funding for the research through the NHS Blood and Transplant Charity, said:

"This insight into public attitudes reinforces the strength of public support for organ donation. Importantly, it shows there is a high-level of public support for further exploring the option of donation following an out of hospital cardiac arrest.

"Organ donation following an out of hospital cardiac arrest is more complex than through intensive care.

"The major challenge is maintaining organ function after the donor's death, as it takes hours for the transplant team and recipient to be made ready.

"However there have been some major technological developments in donor care and organ preservation in the last decade which means we are now looking again at this donation pathway."