Around the world, countries are trying to encourage more people to donate their organs after death to help those desperately in need of transplants. Wales, for example, is poised to become the first country in the UK to introduce an opt-out system, where consent after death is assumed unless families object. Such systems already exist in Spain and Belgium. Meanwhile, a new report by the UK Nuffield Council on Bioethics suggests that the National Health Service tests the idea of paying for the funerals of organ donors as an incentive for donation. And Germany has announced that it wants to make it possible for its citizens to declare their willingness to donate their organs, and have this information stored on electronic health cards.
In The Lancet today, we are publishing a Series of three papers to add to the debate about ethical, policy, and clinical issues surrounding organ transplantation. The first paper in the Series calls on governments to develop self-sufficiency in organ transplantation, which will help to end transplant tourism and organ trafficking. The authors outline the legal and medical components that countries should include in their transplant programmes to achieve this goal.
The next papers in the Series focus on clinical care after kidney transplantation—the most common type of transplant globally. Health systems need to provide good care for patients after transplantation not only to avoid organ rejection and failure but also to prevent the other main causes of morbidity and mortality. Premature death after kidney transplantation is more likely to happen from cardiovascular complications, infection, and cancer than from graft failure. The second paper in the Series details the steps to be taken to prevent cardiovascular disease in patients who receive kidneys. Chronic rejection and failure of a kidney graft is still a major problem resulting in return to dialysis, and the final Series paper focuses on monitoring and management of patients to avoid this outcome.
The ultimate goal for countries should be ethical systems for organ transplantation that not only encourage and support donation but also provide a high standard of care for patients after transplantation.
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