Legal regulation of the transplantation of suboptimal organs

Description

Convenors: Dr Kourosh Saeb-Parsy (Transplant Unit), Dr Matthew Dyson (Law) and Dr Kathleen Liddell (Law)

Organised by a team drawn from Cambridge’s Transplant Unit and the University’s Law Faculty, this workshop examined legal liability for adverse outcomes following transplantation of suboptimal organs. Participants included leading specialists in transplantation, law, health psychology, ethics and policy.

Due to a shortage of suitable organs and the growing number of patients dying on transplant waiting lists, the use of less-than-ideal organs from deceased donors is becoming more common. ‘Suboptimal’ organs include organs from older donors or those with co-morbidities, infections, current or previous cancers, or history of high risk behaviour such as smoking, excessive alcohol intake and illicit drug use. The outcomes from transplantation of such suboptimal organs are generally acceptable for the patient population compared with the even greater risk of death while waiting for an organ. However, compared with optimal organs, sub-optimal organ transplantations expose individual patients to greater risk of transmission of disease and major morbidity, graft loss or death. Recent adverse outcomes – including the death of two kidney recipients – raise questions about the potential for surgeons to be held liable for using suboptimal rather than standard or optimal organs. These liability issues raised related questions about the appropriateness of current legal ‘checks and balances’ on pre-mortem interventions (such as pre-mortem heparinisation) which might improve organ quality.

The workshop built on the organisers’ publication in the Lancet (2015; 386: 719-21). Specifically it sought to generate more detailed debate and develop policy proposals on the following issues:

1. The reasons for, and challenges of, using marginal organs in transplantation;
2. The legal framework for adverse outcomes of suboptimal organ transplantation with a special focus on the torts of negligence and product liability;
3. The desirability of relying on tort law to regulate the use of suboptimal organs;
4. Whether the legal system currently imposes appropriate checks and balances to address the risks of pre-mortem interventions for donors (and their families), alongside the opportunity to improve organ quality for recipients;
5. International perspectives on organ transplantation and the legal regulation of it.;
6. Future research and policy directions.

Following the Workshop, the organisers presented their views on these issues at an international conference in Rome: Ethical, Legal and Psychosocial Aspects of Transplantation.

The organisers are immensely grateful to everyone who participated on the day, and to the Philomathia Foundation for funding the event.