Should Recipients Choose Their Donor? Experience of a New Consent Process in Lung Transplantation

Purpose Consent for lung transplantation in the UK was recently reviewed after public concern when a patient died after receiving lungs from a donor who was a smoker without the specific consent of the recipient. The family insisted they would have refused the organs given the choice. The British Transplantation Society subsequently recommended that all patients should be offered a choice about potential donors. Since February 2012 we implemented a form allowing lung transplant recipients to make choices on donor decisions. Guidance notes were provided to inform patients of the risks associated with organs from donors who: •had a history of smoking •had engaged in high risk sexual or recreational activities •had a malignancy •were over the age of 60 years or •had a significant viral or bacterial infection. Alternatively, patients could choose to accept organs from any donor the transplant team deemed suitable for transplantation. Methods and Materials Donor choices were discussed with patients at the time of transplant assessment. Consent form and guidance notes were provided with a request to complete and return the form. A follow up call was conducted if no response was received. Responses were analysed to obtain a view of the donor preferences of our patients. Results 52 patients were invited to complete a donor choices form and 43 (83%) responded. 84% (n=36) of responders chose to accept any organ deemed suitable by the team, irrespective of specific donor characteristics. Of the 7 (16%) patients who made a defined decision: 3 declined to consider donors with high risk sexual or recreational behaviour; 2 declined to consider donors aged over 60; 1 declined to consider donors with a smoking history and 1 declined to consider donors with a history of malignancy. Conclusions Whilst public demand has warranted a change in practice, and it is imperative to offer recipients a choice about potential donors, the majority trust the judgement of the transplant team to make the right decisions on their behalf.