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The report from the Organ Donation Taskforce looking at the potential impact of an opt-out system for deceased donor organ donation in the UK, published in November 2008, is probably the most comprehensive and systematic inquiry to date into the issues and considerations which might affect the availability of deceased donor organs for clinical transplantation. By the end of a thorough and transparent process, a clear consensus was reached. The taskforce rejected the idea of an opt-out system. In this article we acknowledge the life saving potential of organ transplants and seek to highlight the difficulties that arise when the issue of organ shortage competes with concerns over choice and authorisation in the context of deceased donor organ donation. [ABSTRACT FROM AUTHOR]

Progress in transplantation outcomes depends on continuing research into both donor and recipient factors that may enhance graft and patient survival. A system of licencing for transplantation research, introduced by the Human Tissue Act 2004, which separates it from the transplantation process (then exempt from licencing), has damaged this vital activity by a combination of inflexible interpretation of the 2004 Act and fear of criminal liability on the part of researchers. Now, following the European Union (EU) Directive (2010) on standards of quality and safety of human organs intended for transplantation, new UK Regulations have been drafted, which are intended to implement it. These Regulations impose a compulsory licencing system, similar to that for research, on the whole transplantation process. This goes beyond what is required by the Directive and may even have an inhibitory effect similar to that already seen in research. Initial draft Regulations went further, imposing criminal sanctions for breaches. However, following a public consultation process, the Department of Health (DH) has recently stated that, as a result of the overwhelming view of respondents that the proposed licencing system was unnecessary, all sanctions under the final Regulations are now decriminalised, with the sole exception of operating without a licence. While this does not eliminate the negative effect of licencing, it does suggest an awareness of the DH that excessive regulation unnecessarily harms the transplantation process. An opportunity thus arises for the Human Tissue Authority (the regulatory body for both the new licences and research licences under the 2004 Act) to end the current illogical and harmful separation of transplantation and transplantation research by ensuring that all centres licenced for organ donation, retrieval and transplantation are also fully licenced for related research. [ABSTRACT FROM AUTHOR]

The article offers the author's insights on living donor kidney transplantation. She mentions that encouraging adult to voluntarily donate a kidney by providing adequate information about the process and recognising the value of their donation is in accordance with the ethos of National Health Service (NHS) in Great Britain. She adds that the kidney donation guidelines emphasise on the significance of the donor's welfare.

This article proposes that in a situation of posthumous organ and tissue donation the cadaver has no individual rights and that family rights should in no way automatically outweigh the potential transplant recipients' right to a life-saving treatment. It explains that clinical transplantation and transplant immunobiology is a revolutionary area of medicine which has saved thousands of lives. It says that with this proposal many lives will be saved.

This manuscript reports on a landmark symposium on the ethical, legal and technical challenges of xenotransplantation in the UK. King's College London, with endorsement from the British Transplantation Society (BTS), and the European Society of Organ Transplantation (ESOT), brought together a group of experts in xenotransplantation science, ethics and law to discuss the ethical, regulatory and technical challenges surrounding translating xenotransplantation into the clinical setting. The symposium was the first of its kind in the UK for 20 years. This paper summarises the content of the expert lectures showcasing the progress which has been made in xenotransplantation including-the history of xenotransplantation, advances in gene edited animals and progress towards clinical xenotransplantation. We then set out the ethical and legal issues still to be resolved. Finally, we report the themes of the roundtable discussion highlighting areas of consensus and controversy. While the detail of the legal discussion was directed towards the UK, the principles and summary reported here are intended to be applicable to any jurisdiction seeking to implement clinical xenotransplantation., Competing Interests: Competing interests: David Ayares is the chief scientific officer of Revivicor, Inc. David Cooper Consultant to eGenesis Bio, Cambridge, MA, USA. Jayme Locke receives grant salary support from Lung Biotechnology PBC, a subsidiary of United Therapeutics., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case to (1) examine the role of the Court of Protection in cases relating to patients with impaired decision-making capacity who require a transplant, (2) to highlight the lack of empirical data on patients who have faced inequitable access to transplant and (3) highlight the shortcomings of the existing legal and regulatory framework in England and Wales guiding clinical decision making for patients in William's position. We consequently argue that there is a clear need for action to ensure equitable access to transplant for those in William's position. Furthermore, we suggest that there is a responsibility incumbent on policy makers and clinicians alike to develop a meaningful, and meaningfully operational, framework centred on preventing discrimination against potential organ recipients based on their decision-making capacity., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.