Press red button, donate kidney
Authors: Joanna Lyall
Journal: BMJ (2005)

As from Monday, television viewers will be able to add their names to the NHS Organ Donor Register by pressing the interactive red button on their digital handsets. This innovation—using the kind of interactive technology that has long been a feature of television charity appeal shows such as Children in Need—will be available throughout a new week long BBC season on organ donation, known as DoNation.

Some transplant surgeons and medical ethicists have welcomed the idea for its potential to reduce the huge shortage of organs. More than 6000 people are currently awaiting transplants in the United Kingdom, and last year 2242 transplants were carried out. About 400 people die each year waiting for a transplant, according to UK Transplant, which has cooperated in the making of the series.

A telephone survey of 1206 people carried out for UK Transplant and published in March 2003 found that 90% supported organ donation, but under 20% were on the register. Four per cent opposed the donation of organs to help others. UK Transplant has also established regional variations in willingness to donate. Gateshead has the highest proportion (36%) of its population willing to donate, followed by Basingstoke, Dunfermline, Cardiff, and Taunton.

DoNation's producer, Edwina Vardy, will not speculate on how many new names the programmes might add to the register but she hopes that the series—made at the Free-man Hospital, Newcastle, Papworth, and the Royal Free and St Mary's hospitals, London—will get people talking about the issues. “Most of us support organ transplantation yet only a minority are on the register. There seems to be quite a lot of ignorance about the subject,” she said. “You are more likely to need a transplant than become a donor.”

The series will include five documentaries about people waiting for an organ transplant and a programme following a kidney transplant from a live donor. In an interactive Casualty/Holby City special viewers will be able to vote on which of two patients competing for an organ should get it. A website (bbc.co.uk/donation) will include a link to sign up to the register with e-cards to send to family and friends to inform them of the decision.

“Everyone would have a transplant to save their lives but the organ donor rate in the UK—13 per million—is the lowest in western Europe. And we probably have the highest proportion of relatives—40%—who say no when approached in intensive care,” said Chris Rudge, medical director of UK Transplant.​Transplant.




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Mr Rudge, a former transplant surgeon, said: “Every bit of media attention that helps get more people on the register is to be welcomed.” UK Transplant, a special health authority, which manages a national transplant database and maintains the National Organ Donor Register, has set a target of 16 million on the organ donation register by 2010. At present the total number on the register, which was established in 1994, is 12.4 million.

John Forsythe, president of the British Transplantation Society and a consultant transplant surgeon at Edinburgh Royal Infirmary, also welcomed the series' potential to provoke debate. “Publicity and education are key issues,” he said. “Transplantation is a great success story but we are still short of organs. Death is a very taboo subject but we need to encourage people to talk about it and make their wishes known,” he said. “Spain had a major publicity campaign and it is top of the league internationally.” The donor rate in Spain is 34 per million.

Raanan Gillon, emeritus professor of medical ethics at Imperial College London, said enabling viewers to join the donor register while watching television was “brilliant.” He said, “My personal preference would be a change in the UK law towards `presumed consent' unless a person had actively opted out of being a donor. But in the absence of such a change, widespread encouragement to opt in is necessary if people's organs are not to go to the worms or the flames instead of saving lives.

“The only significant argument I can imagine against television interactive donation is that such decisions need careful discussion with relatives. But the programmes will often be viewed by families and partners so discussion will be encouraged.”

Dr Arthur L Caplan, director of the Center for Bioethics at the University of Pennsylvania and editor of The Ethics of Organ Transplants, said, “It helps to make it convenient to give people an opportunity to sign up to be an organ and tissue donor. However, it is very important that any such site reminds those who sign up to tell their family and friends that they have done so. This will minimise the all too common situation of someone wanting to be an organ donor but having their family over-ride or neglect their wishes because they were unaware they had signed up to do so.”

The effect of the interactive facility would be limited, he suggested. “Most people are not going to be using this technology, and since organ donors are rare you need tens of thousands of people to sign up to generate one donor.”

But Magi Sque, a senior lecturer in the school of nursing and midwifery at South-ampton University, who has made a three year study of families who agree to let a relative's organs be transplanted, said that television was a key factor in informing their decision. “Most people get their information on transplantation from television,” she said.

More than a quarter of kidney transplants (27%) now involve an organ taken from a live donor. The Department of Health and UK Transplant are taking steps to increase living donor donations. (http://news.bbc.co.uk/1/hi/health/4586565.stm).

Andrew Raftery, consultant transplant surgeon at Sheffield Kidney Institute, said he hoped the DoNation programmes would serve to make these initiatives unnecessary. He added that although he carried out some transplants from live donors he was against moves to increase living donation. “Taking out a kidney is a major procedure and I have reservations about patients undergoing operations that are of no benefit to themselves. Although the mortality rate is low—about one in 3500—there is a risk.” He believed efforts should be concentrated on increasing cadaveric organ donation.