The Donation Dilemma

Donation DilemmaBroadcaster: BBC News

Year: 2015

Genre: Documentary


Review by Emma Sterling

For people from an ethnic minority background like me and my family, finding yourself in a situation where you need an organ transplant can sometimes feel like a death sentence.”

This short documentary (26 minutes) investigates the lack of Black, Asian, Minority ethnic group (BAME) organ donors and explores the influence this shortage has on the transplant black market overseas. The programme follows BBC news presenter Seb Choudhury as he donates a kidney to his mother Sakina, who had been given 3 years to live without a transplant (whereas the waiting list without his intervention might have been up to 10 years).

Although approximately 11% of the British population are from BAME backgrounds, only 3.7% (March 2015) of people on the organ donor register are from this group. Seb Choudhury speaks to Faruk Choudhury, the first Asian mayor in Bristol, who wants to promote blood and organs donations in BAME. They discuss some of the biggest barriers to reaching minority ethnic groups including religion, cultural issues and lack of knowledge. The need is particularly pressing since their predisposition to conditions such as hypertension and diabetes mean that BAME make up as many as a third of the transplant waiting list. Transplants within the same ethnic group tend to be more successful as certain blood types and HLA groups are more common within ethnic groups. The compatibility of the donor and the recipient HLA antibodies must be tested using crossmatching (see Understanding crossmatch testing in organ transplantation: a case-based guide for the general nephrologist Nephrology, subscription required). Successful crossmatch testing and blood group compatibility reduces the chance of organ rejection. Currently BAME patients are waiting an average of a year longer on the NHS than others due, in part, to the lack of suitable matches.

This extended wait has opened a gap for a black market in transplants. The documentary looks at this market in Bangladesh, where people from disadvantaged backgrounds are desperate for a way out of their circumstance and are persuaded to sell a kidney. They are promised large sums of life-changing money in return, and given false medical information that frequently omits the risks of the operation. The kidneys are often taken from these donors in botched surgery that leaves extensive scarring, with no aftercare at all. Donors are often left in a worse position than before, unable to return to work due to post-operation complications, as well as the social stigma attached to selling your organs. To add insult to injury, 81% of the exploited donors are not given the money they were promised. These kidneys are then sold to wealthy people who’ve come from abroad in need of a transplant costing around £16,000. Only a small fraction of this reaches the original seller.

The first thing that can be done is to reduce demand by encouraging more voluntary donors in the UK, particularly those who are BAME. In some countries like Wales, an opt-out (presumed consent) system has been introduced, where members of the public are automatically on the donor register unless they decide to remove themselves. However, there are objections to this model, since it represents a fundamental shift in the notion of donation being a gift.

Many people are unsure whether their religious obligations are compatible with becoming an organ donor. Whilst most of the leaders of the major religious groups in the UK see donating organs as life-saving act of generosity, potential donors are encouraged to check with your religious leaders if they are unsure see (see also NHS: What does my religion say?)

Advances in science could mean that, in years to come, the need for donor organ  would be reduced by the ability to grow them instead. Biologists around the world have been building organoids or ‘mini-organs’ from stem cells (e.g. see this Channel4 news clip). Research using these organoids could be the foundation for eventually growing whole organs using stem cell culture.

For further reading on the potential of organoids see:
Tissue engineering: organs from the lab (Nature, open access)

Additionally, research into xenotransplantation could see genetically modified animal organs being transplanted into humans. Pig-to-primate organ transplants have been performed successfully worldwide however, no team has seen a primate with such a transplant survive for more than a few days.

For further reading on xenotransplantation see:
New life for pig-to-human transplants (Nature, open access)

In the meantime, donating an organ is an important, yet very personal, choice and whilst it would be wrong to place pressure on specific groups to donate, raising awareness of the need and debunking some of the myths surrounding organ donation is a vital step to saving more lives.


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