When the Chronicle met Dr. Lorna Williamson OBE, Lucy Cavendish Fellow Commoner and Director of Publishing and Engagement with the Royal College of Pathologists, we were utterly confounded by the question of live organ donation. Just how complex is the ethical framework for performing this kind of transplant? How does social media complicate the issue still further? And who on earth voluntarily gives up a kidney to a total stranger? Here, Lorna does her best to relieve us of our ignorance.
Hello again Lorna! Live organ donation sounds fascinating. Can you tell us a bit about your work in that area?
Absolutely! In my new role with the Human Tissue Authority, I get involved in some cases of living donors. Most living donation happens within a family or a couple, and it’s usually a kidney, but there have been some fascinating cases. So sometimes you’ll have two partners and one wants to donate to the other, but they’re the wrong blood group or a bad tissue match. And then you might have another pair in a similar situation. NHS Blood and Transplant runs a computer matching scheme, and sometimes you’ll get these two couple showing up as a cross match – so Couple A will donate a kidney to Couple B and vice versa. You can actually have a triangle arrangement too, to get a three-way transplant exchange.
But what’s even more amazing is people who come along and say “I want to give a kidney, I don’t know anyone who needs one, but I’d just like to donate.” That can definitely happen, and they can help one patient on the waiting list, but if you combine that with the triangle arrangement I’ve just described you now have an open chain. Your altruistic donor gives to Couple A, they give to Couple B, who then give to Couple C, so you can in theory create a chain as long as the number of waiting recipients who are a match for the next donation in line.
It seems astonishing that someone would say, out of the goodness of their hearts, “I want to give away one of my kidneys to a stranger.” How risky is the procedure for them?
Well, what they’re told is that they’ll be monitored for the rest of their lives, and undergo fairly regular testing. You probably have a higher chance of getting raised blood pressure as you get older so that’s something to watch, but in terms of kidney function yes, you can absolutely function on one kidney. It will get bigger, and it will do the job.
Yes. Actually I think even more amazing to me are the people – and I can think of three off the top of my head – offering to give a lobe of their liver to anyone who might need it, in the knowledge that it will end up potentially saving a life. People are just extraordinary. A lobe of liver would normally go into a child, and the rest of the donor’s liver will grow larger in order to keep functioning. You can even have a drink or two! But it is a much bigger operation, a much more serious bit of surgery. Truly, reviewing these cases does make me feel good things about humanity in general.
We feel pretty hopeful now ourselves! So, where does social media fit into all this?
Well, these days you have people taking to social media platforms to say “Hey, I need a stem cell transplant” or “I need a kidney”, and more or less advertising for a donor. And that throws up some interesting ethical challenges, as well as the practical questions of how this might be arranged. Clearly it’s illegal in this country to sell or buy organs, and all living donors – particularly the altruistic ones who want to donate to a stranger – go through a thorough assessment process to make sure they have capacity to consent to this kind of procedure and know exactly what they’re doing. This is where we get to make sure that somewhere along the line they’re not being paid for it, or that they’re not being put under duress or coercion if the recipient is known to them. Imagine if it was somebody’s boss demanding a kidney, for example!
But the social media thing gets you into some interesting ethical territory.
So they’re donating to a named individual, but it’s not an individual with whom they’ve had any previous social or emotional connection. How you then try and assess whether this is a freely given act of generosity or whether there’s something lurking in the background is really quite tricky.
My colleagues in Canada had to deal with a case where the owner of a famous ice hockey club needed a new liver, and went very public with his request. He had fans of the club lining up to donate. OK, so he did find a donor to see it through, but it does open up a whole new load of questions around advertising for a donor and the power dynamic involved. Medical ethics is a complicated field!
Well, quite. We’re not sure if we can usefully ask any more questions without going away and raiding the library shelves for books on the subject, but thank you so much for shedding some light on such a fascinating area of medicine!
Look out for more from Lorna in the upcoming weeks.