How a dead man provoked an ethical dilemma that has convulsed the NHS

THE CONTROVERSIAL decision of the UK Transplant Support Service Agency to accept racist conditions for an organ donation may be just the tip of the iceberg.

The Department of Health says families of dead donors often try and put conditions on organ donations. It says the family of a non-smoker sometimes stipulates that a relative's lungs may not go to a smoker, and that the parents of a child killed by a drunk driver sometimes request that the child's liver is not given to an alcoholic.

John Evans, chairman of the British Organ Donor Society, says this case is unlikely to be the first where racist conditions have been accepted: "It could have happened in the past, but this is the first case where there is evidence to support it. With the number of organ donations . . . there must be some that put constraints on their donations. Then it would be down to the professional. There would be some that would find it unacceptable, some would attempt to show the families the error of their ways and there would be those who would have gone ahead and done it," he said.

There is nothing in law to stop such conditions being accepted by the UK transplant service, which co-ordinates organ donations throughout the country. But it has a policy that all families who try and place restrictions on donated organs should be counselled by a transplant co-ordinator to remove any conditions other than those dictating which organs can be used.

Organ donation is covered by the 1961 Human Tissue Act, which makes no reference to setting conditions. But Frank Dobson, the Secretary of State for Health, said yesterday: "I haven't been an opponent of apartheid all my adult life to see it being introduced in the NHS. We will not tolerate it. It never occurred to me that a rule would be necessary to keep racism out of blood transfusions and donations. If it needs introducing then we will introduce it."

Mr Dobson launched a government inquiry into Tuesday's donation within hours of hearing that the UK transplant service had allowed relatives of the donor to stipulate that the donated kidneys could only be used if they "didn't go to a coloured". The organs were removed from the donor at the Northern General Hospital in Sheffield last July and later given to a white patient at a hospital outside Yorkshire.

Phil Taylor, the acting chief executive of the hospital, was adamant that his unit obeys NHS guidelines preventing stipulations being placed on the use of donated organs. "Under no circumstances could we condone conditions being placed on the consent given for the donation of organs," he said.

A spokesman for the hospital said that if a patient or patient's family stipulates that the recipient of the organs should be white, the harvesting of them was forbidden under the guidelines and since any donor's organs must be re-transplanted within hours, there was no possibility that they may have been harvested pending attempts that the restrictions for use be removed.

One of things Mr Dobson's inquiry will have to establish is whether these rules were flouted by any of the hospital's team of transplant co-ordinators, the specialists responsible for liaison between a donor or his family and the UK Transplant Support Service Authority. Co-ordinators' guidelines say it is "essential to keep a written record of enquiries made and their outcome," and one possibility is that the donor family's stipulation was recorded on a scribbled note on the patient's file and was in some way retracted before harvesting took place.

Staff at the UK Transplant Support Service Authority contacted Simon Newell, the Unison representative about the "whites only" organ. Mr Newell wrote to Robina Balderson, the head of the authority, highlighting the case. Then the media got hold of the story.

"I feel my actions have been totally vindicated," Mr Newell said.

"Our members were greatly concerned about this because the authority is supposed to be providing a public service and by acting in this way they isolate a huge percentage of the population. They felt they could have been seen to be acting in a racist way."

The case has sparked an intense ethical debate as to whether or not donor organs can be accepted under such conditions because of the shortage of donor organs available. A significant number of doctors believe they should. A 38-year-old female GP, from the south east of England, said yesterday: "In an ideal world it would be wrong but this is not an ideal world. If you have a child that is a match for an organ are you going to deny that child the chance of life for the sake of political correctness? The real issue is that no one has to donate. I don't think any doctor is going to deny a patient the chance of life."

Some 200 people died waiting for organ transplants last year and 6,629 people were on the waiting list. One in four heart patients die waiting for a donor. Last year there were only 822 donors, the lowest for 10 years. There are fewer fatal road accidents, down from an average of nearly 6,000 during the 80s to less than 4,000 during the 90s and fewer people carrying donor cards. The most common transplants are kidneys, with 1,000 operations carried out each year, followed by around 600 liver transplants.

There is a severe shortage of Asian donor organs so Asian people who undergo transplant operations often have to receive organs from people of other races. Although it is widely believed that inter-racial transplants increase the risk of rejection, Professor Andrew Bradley, head of surgery at Cambridge University and a world authority on transplant surgery, said that the practicalities of transplantation meant the ethnic origin of donors had little or no effect on the chances of success.

"We all have marker or flag cells in our bodies which need to be matched as best as possible for a transplant. A match is more likely within ethnic groups if the recipient and donor are from the same group," he said. "But matches between people of different ethnic background do happen and, more to the point, we do not look for matches between races but matches between individuals - race has no practical importance."

Dr Evan Harris, the Liberal Democrat MP for Oxford West & Abingdon, said that the lack of organs could be solved by having a system where people had to "opt out" of being a donor rather than having to carry a card to say they want to be donor.

"There are fewer and fewer transplants being done each year and there are more and more people joining the waiting lists," he said.

"Most European countries use this system and this has increased the supply or organs and has been well received in countries like Belgium."

`It's Racist And Wrong'

Dr John Ashton, retired GP, Birmingham: "It is quite wrong. It is racist and we cannot allow it."

Jonathan Clowes, 37, a public health specialist in West Yorkshire: "If we go down the road of racism to fill a need that could be filled in other ways that is morally wrong."

Michael Wilks, a police surgeon in west London: "If conditions were imposed on me I would do my best to resist them but if relatives insisted I would then not be able to proceed (with the transplant)."

Paul Betts, the father of 18-year-old Leah, who died in 1995 after taking ecstasy: "I fully support all organ transplants. I didn't until Leah died, but it was her request that she wanted to help others by having her organs transplanted... It is like saying that black people are not worthy to receive these organs."

Professor Andrew Bradley, head of surgery at the University of Cambridge: "If we accept an organ on condition of race then we are saying anything from religion to diet can follow."

BMA spokesman:`"This situation will place doctors in an almost impossible ethical dilemma."

Vivenne Nathanson, head of ethics at the BMA: "I am extremely surprised in the transplant service if this allegation is correct that they accepted the organ on these conditions."