Week 5: Organ Donation

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Week 5 Organ Donation
Monday 21 May
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Organs and tissue

• Human tissue
• Nerve
• fascia
• Bone, Marrow
• Tendons
• Heart valves
• Corneas
• Skin
• Stem cell lines (have ability to become anything
  in the body)

3
Organs and tissue

• 30 transplantable parts
• more than 130 pieces of tissue
• Extracted, sterilised, dissected repackaged

4
Surgical removal of human organs tissue for
therapeutic purposes
What is a non-therapeutic purpose? See HTA,
CPTCO, HT(OD)A Bill
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HT(OD)Amendment Bill

• Preliminary Provisions
• Part 1 s5(1)
• organ means human tissue, other than
• Blood
• Reproductive cells and embryonic components and
  includes but is not limited to
• (a)________
• (b)________

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How did the HTAct 1964 define organ, tissue
death?
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Legal status of the corpse

• no property right
• temporary ownership with? person in lawful
  possession

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Who is the person lawfully in posession of the
body?
See Health Dept CPTCO Clauses 1.1-1.2
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PROBLEM
NZ has one of the lowest organ donation rates in
the world 7 organ donations per 1 million people
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High Maori Resistance

• Only 6 Maori families consented to organ donation
  (1988-1996)

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Concern

• Respect for /fear of dead
• Vs
• Need for human tissue

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Alder Hey Hospital - UK

• Secret removal stockpiling of childrens organs
• www.rlcinquiry.org.uk

• Pof Dick Van Velzen in charge
• lied to parents stole records falsified
  reports
• Taken 2,000 hearts, brain parts, eyes from
  foetuses, 1,500 stillbirths, childrens heads
  bodies

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Consequence

• 50 drop in organ donations
• Recognition of need for legislation
• ensure fully informed consent

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Alder Hey Hospital - UK

• But Alder Hey research
• saved 1,600 childrens lives
• 1999 104,300 body parts entire bodies of
  stillborn babies foetuses found in other UK
  hospitals medical schools
• Some sold to drug companies Ministry of Defence
  

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• Cartwright Inquiry (An Unfortunate Experiment)
  -1987
• Estab Health Disability Commissioner Code of
  Conduct
• Code of Health Disability Services Consumers
  Rights

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Maori complaints - 1991

• Pathologists removed organs from Maori bodies
  without consent
• Alleged that removals not necessary (Pahl
  article) to determine cause of death
• Breached Maori cultural sensitvities

• Consequences
• Maori mistrust of medical profession
• Cultural aversion to organ donation intensified

17
Greenlane Hospital NZ (2002)

• Childrens heart library
• 1,300 hearts taken stored without consent
• Used for research teaching
• Further 310 body parts found in old lab

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Andy Tookey daughter Katie, who needs a liver
transplant
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NZ Legal Framework

• Human Tissue Act 1964
• Health Department Code of Practice for
  Transplantation of Cadaveric Organs 1987
• Human Tissue (Organ Donation) Amendment Bill 2006
• Coroners Act 1988
• Code of Health Disability Services Consumers
  Rights 1996
• Common Law

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Human Tissue Act 1964
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Section1 - Short Title and Commencement

• An Act to consolidate certain enactments of the
  General Assembly relating to
• Post-mortem examinations
• The practice of anatomy
• The removal of human tissue for therapeutic
  purposes and for purposes of medical research and
  research

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Section 2 Human Tissue

• Lacks definitions
• Lacks sufficient definition of terms
• Eg body means dead body but does not include body
  of a stillborn child
• Compare with HT(OD)ABill
• Death (brain dead definition controversial)
• Organ (defn wide)

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Section 3 Removal of Human Tissue for
therapeutic purposes

• Therapeutic human tissue cells, cellular
  tissue-based therapies
• Eg organ and tissue transplantation, cellular
  therapies
• Non-therapeutic purposes
• Eg Anatomical medical research

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Section 3 permits removal of human tissue for
therapeutic or medical educ/research purposes if

• Person requests (consents) that his body (or body
  part) be used for this purpose after his death
• Request in writing or oral
• Before 2 witnesses
• During his last illness

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What do you think?

• Homer informs his family in writing of his wish
  to donate his heart, liver and cornea
• Homer records this wish in his will
• Marg and the family object to these wishes
• Homer dies

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What do you think?

• Can Marg override Homers written wishes? (see
  CPTCO, 4.1, 4.1a, 4.3 but also see the Bill
  s4(c), s6 (new s3)
• What law will assist Marg? (see CPTCO, 4)

• Would it make any difference if Homers wishes
  were only made orally? No (see HTA, s3 Bill s6
  (new s3)
• What law will ensure Homers wishes are carried
  out? (Bill s4(c), s6 (new s3)