The Intensive Therapy Unit (ITU) is where patients with the most serious and life-threatening conditions are cared for within the hospital. Sadly there are a small number of patients who, despite the best efforts of the ITU team, are just too unwell to survive. In these cases the team will move from actively treating them to providing the best possible End of Life Care (EoLC).
As part of providing EoLC the ITU team will explore any wishes that the patient and family may have, including religious and spiritual support, and whether any significant family or friends should come to the hospital to say goodbye. The option of organ and tissue donation may also be discussed at this point.
Organ donation is rare and can only take place within the ITU when the patient is attached to the ventilator (breathing machine). Of all the people who die in the UK per year (approx. 600,000 in 2017) less than 1% are actually eligible to be considered for organ donation. Not everyone who can be considered will go on to be an organ donor for a variety of reasons, including past medical history or current clinical condition. A specialist nurse invited in by the ITU team will assess whether someone could potentially be an organ donor and will only discuss this with the family of the patient if it is a possible option.
The law around organ donation changed in 2020, and most adults in England are now considered to have agreed to be an organ and tissue donor when they die unless they have recorded a decision to 'opt out'. There are exclusions for people under the age of 18, those who lack mental capacity to make a decision, people who have not lived here for 12 months, and those who are not living here voluntarily.
This means that if someone has not confirmed whether they want to be an organ donor – either by recording a decision on the NHS Organ Donor Register or by speaking to friends or family – and is not in one of the excluded groups, it will be considered that they agree to donate their organs when they die.
Their family will still be consulted, and a specialist nurse will discuss it with their relatives and ask them to support the patient's wishes.
If the family agree, there will be a comprehensive assessment of the patient's medical history and donor organs will be 'matched' with people on the transplant waiting list. The organs will be removed at the hospital where the donor is being treated, and then transported by specialist teams to the recipient, who is usually in a different hospital.
For more information please visit the following websites and watch the NHS Organ Donation video:
NHS Blood and Transplant website: https://www.nhsbt.nhs.uk/
NHS Organ Donation: https://www.organdonation.nhs.uk/