Surgeons at odds over donor organs

A SURGEON has revealed that, over several years, he kept dying people alive so that their organs would be fresh for transplantation.

The practice was then declared unlawful in NHS guidelines - but Hany Riad, now a consultant transplant surgeon at Manchester Royal Infirmary, wants the law changed.

Mr Riad, who helped save the lives of dozens of people, kept comatose patients alive when he held a previous position in Exeter. He and colleagues harvested 67 kidneys, hearts, livers, corneas and heart valves fromsuch patients.

Opponents say the practice - known as elective ventilation - treats the people involved as living dead.

Mr Riad says the Exeter kidney transplant rate was double the national average, saving the NHS money and helping patients on waiting lists for organs. In a letter to the British Medical Journal, he and two colleagues say the Government must legitimise what they describe as a humane, practical idea.

The call for elective ventilation to be legalised comes amid growing concern about the widening gap between the numbers of organs needed for transplant and those available. Last year, 50 people died waiting for a heart transplant.

The UK Transplant Support Service Authority says there are about 6,000 people on waiting lists for donor organs, but fewer than 3,000 transplants each year. One of the main obstacles to improving transplant rates is the lack of donor organs.

Mr Riad says that in six years at Exeter until the practice stopped last year, 25 patients were electively ventilated, providing 41 kidneys, two hearts, three sets of heart valves, one liver and 20 corneas for transplant. "We sat down with the families, asked if the patient was in favour of organ donation, and explained what would happen. We don't give them any false hopes or anything like that. We do no overt harm and the good is clear for all to see. NHS resources are being diverted into expensive dialysis programmes for an increasing population of patients with chronic renal failure. Elective ventilation unlocks money from dialysis budgets because transplantation is cheaper."

With elective ventilation, patients with little time to live are identified as potential donors, moved to intensive-care units and ventilated to enable organ retrieval to take place. An NHS guideline issued last year said legal advice "indicates that, in cases where the clinician's intention in referring the patient to intensive care is not for the patient's own benefit, but to ensure his or her organs can be retrieved for transplantation, the practice would be unlawful".

Dr Sheila Willatts, consultant in charge of the intensive-care unit at Bristol Royal Infirmary, said in a report on the Exeter procedure for the BMJ: "It is implicit that all care is delivered for the benefit of any patient admitted to an intensive-therapy unit. This is clearly not the case in those who were transferred at Exeter."

She added: "For some doctors, the needs or rights of the living seem overwhelming, but they threaten to overcome the rightsand respect that should be afforded to the dying."