2. Paying for donations
Greater Glasgow Branch
(R) That this meeting of RCN Congress asks Council to lobby against any moves to change the law to enable payment for live tissue donation
Result
The resolution was .
For: 293 (80.94%)
Against: 69 (19.06%)
Abstain: 26
Resolution passed.
Debate report
Nursing student Anthony McGeown from the Greater Glasgow branch opened the debate by outlining his concerns about payment for live tissue donation, saying it could exploit the vulnerable and deprived. It could result in a black market for organs he said, citing a case in China where a child had sold his kidney in exchange for an iPad.
“Nurses are patients’ advocates,” Anthony stressed. “If we legalise live tissue donation now, the donors of today will become the recipients of tomorrow. I urge you to support this resolution.”
The proposal was backed by David Cardwell of the RCN Perioperative Forum who said: “Organs don’t come with barcodes.” Others agreed with Elizabeth Nightingale from the Leeds branch saying organ donation should be a “gift of life” and renal nurse Nykoma Hamilton saying dialysis patients would be appalled by the idea.
David Baker from the Hampshire branch urged caution against a total rejection of payment for organ donation. “I’m not wholly against it,” he said. “It might increase the number of donors.” He went on to say that he thought it was too early for the RCN to be setting out its view on this and that he wanted to see more collaborative working to reach better solutions to a shortage of donors.
There was support from the floor for an opt-out system of organ donation and the proposer, in his closing remarks, reiterated that he didn’t believe this would be the end of the debate. The resolution was passed with 81 per cent of the vote.
Background
The buying or selling of organs or human tissue is illegal under the Human Tissue Act (Parliament, 2004). Penalties are up to three years imprisonment, a fine, or both. The Human Tissue Authority (HTA) and NHS Blood and Transplant (NHSBT) both issue clear advice that donors may only receive reasonable expenses in accordance with the Human Tissue Act. In October 2011 the Human Fertilisation and Embryology Authority (HFEA) announced that in the future, clinics will be able to offer sperm donors a fixed sum of £35 per visit (including expenses) and a fixed sum of £750 (including expenses) per cycle of donation for egg donors.
On 2 August 2011 the British Medical Journal published a Personal View article (Roff, 2011) by Sue Rabbitt Roff, Senior Research Fellow at the University of Dundee, which suggested a move towards the regulated paid provision for live donors' kidneys. This was widely picked up in the national media - including the BBC, the Telegraph and the Daily Mail; the coverage also included quotes from Kidney Research UK, the National Kidney Foundation and the BMA Medical Ethics Committee rebuffing her suggestions.
In October 2011 the Nuffield Council on Bioethics published a report (Nuffield Council on Bioethics, 2011) considering how far society should go in encouraging people to donate their bodily material, and concluded that while altruism should continue to be at the heart of donations this does not exclude the possibility of some form of reward in some circumstances. The report suggests the NHS should introduce a pilot scheme to test the idea of meeting funeral expenses for those who sign the Organ Donor Register and subsequently die in circumstances where they could become organ donors, and also proposed introducing a pilot scheme that offers payment above and beyond expenses to those prepared to donate eggs for research purposes.
The NHSBT responded stating that no payment, over and above the direct reimbursement of costs incurred in being a donor, should be made to living organ donors. In addition, the HTA responded stating that the practice of non-payment for body parts is fundamental to the success of both living and deceased organ donation in this country and that this definitive expression of the unacceptability of such action provides society with clear and precise direction.
In January 2009 the RCN launched a membership wide consultation on the issue of organ donation which indicated the majority of members were against changing the existing law and moving to an ‘opt out’ system, and that there was broad support for the work of the Organ Donation Taskforce. Members recognised the clear ethical challenges associated with organ donation, noting that a cultural change was required to make organ donation the norm rather than the exception and that nurses were often the first clinicians to broach this difficult subject with the relatives of potential donors.
Following the 2009 member consultation, RCN Council agreed to support retention of the current ‘opt in’ system, and to monitor progress of the UK wide Organ Donation Taskforce Report recommendations until 2013. This position was re-stated in the RCN’s January 2012 response to the Welsh Government White Paper consultation on proposals for legislation on organ and tissue donation. At present, the RCN does not have a position on payment for live tissue donation.
References and further reading
Nuffield Council on Bioethics (2011) Human bodies: donation for medicine and research, London: Nuffield Council on Bioethics. Available at: http://www.nuffieldbioethics.org/sites/default/files/Donation_full_report.pdf (accessed 1/3/12).
Parliament (2004) Human tissue act, Norwich: Stationery Office. Available at: http://www.legislation.gov.uk/ukpga/2004/30/contents (accessed 1/3/12).
Royal College of Nursing (2009) Policy Unit Policy briefing 01/2009 Organ Donation consultation, London: RCN. Available at:
www.rcn.org.uk/__data/assets/pdf_file/0010/287794/01.09_Organ_Donation_new_version.pdf (accessed 1/3/12)
