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The Human Tissues (Transplantation, Post-mortem, Anatomical Examination and Public Display) Act 2024 was formally passed by Parliament on 21 February, and subsequently passed by the President of Ireland, Michael D Higgins, on 28 February 2024. It was enacted. Fields such as organ donation and transplantation. This article looks at what has happened so far and what to expect in the future.
History of kidney transplantation in Ireland
The first kidney transplant was performed in Ireland in 1963. Then came the first heart transplant in 1985, the first pancreas transplant in 1992, the first liver transplant in 1993, and the first lung transplant in 2005.
Some people travel to the UK for transplants, and strong links continue to exist between the two jurisdictions, including the UK's paired kidney exchange program and other pediatric transplants (other than kidneys). Figure 1 Here is an overview of previous transplants in Ireland.
When the Irish Kidney Association (IKA) was founded in 1978, one of its first acts was to introduce the Kidney Donor Card, which later became the Organ Donor Card as we know it today. The association has been at the forefront of promoting organ donation for more than 45 years, and is no exception when it comes to advocating for legislation in the areas of organ donation and transplantation.
The introduction of cyclosporine as an immunosuppressant in the early 1980s was a game-changer for organ transplantation. Since then, development of immunosuppression has continued, with new agents and finer adjustments in dosage emerging.
Figure 1: Overview of transplants to date in Ireland
Organ Donation and Transplant Law
Legislation for organ donation for transplantation has been in the works for many years. The Human Organs and Tissues Bill 2008 expired with the dissolution of the Dail and Senate in 2011. Senator Mark Daly has been an active supporter of IKA's work in this area since first joining the Seanad in 2007.
Under the direction of past and present IKA Boards, staff have carried out important work influencing the development of national and EU policy. Over the years, IKA has brought its experience in promoting organ donation to discussions about what is happening in other countries and, in many cases, how and why changes have been made to the way organ donation is provided. have sufficient understanding. .
After around 8,000 organ transplants, the Human Tissue Act 2024 provides for the first time a national legal framework for operating organ donation and transplant services in Ireland, replacing the almost two-century-old Anatomy Act of 1832. will be abolished.
It is encouraging to see bipartisan support for advancing organ donation and transplant services throughout the legislative process. IKA has been active at every step. Provide explanatory documentation to all parties. Suggest some amendments to improve the bill. and ensuring that the patient, donor, and donor family perspectives are included in the conversation.
The association's work in relation to this legislation has established its reputation as a partner in the future development of organ donation and transplantation services. Our work includes holding an Oireachtas briefing last November and meeting with Department of Health officials and Minister for Health Stephen Donnelly.
Although the IKA did not achieve everything we wanted in terms of the amendments, the Minister agreed to an amendment that commits to reviewing opt-out registrations within three years of the commencement of the registration itself.
This will be important in putting organ donation and transplantation back on the political agenda and allowing us to reflect on and learn from the experience of the past three years. As the front line of promoting organ donation in the community, IKA plays an important role in this consideration.
There are many facets to the human tissue method, each of which requires preparatory work (training, education, etc.) and infrastructure before it can be fully implemented. Therefore, nothing has officially changed yet in terms of hospital practice, and an opt-out organ donor registry has not yet been established. Awaiting timeline for rollout of changes.
Figure 2: Overview of current and potential new organ donation systems
What changes will the human tissue method bring?
Altruistic donations: The new law includes undirected altruistic donations for the first time. Altruistic kidney donation involves members of the public coming forward to donate a kidney to the transplant pool, and the recipient remains anonymous.
According to the Human Tissue Act, “an undirected altruistic donor cannot direct or designate that his or her organs should be donated or not donated to a particular class of persons.” Previously, if someone wanted to (altruistically) donate a kidney to a stranger, they had to go to Belfast or abroad.
Introducing opt-out registration and presumed consent:
An official online opt-out register records details of people who choose not to be considered as potential organ donors. Figure 2 This shows how the approach to family recognition changes.
All those who do not opt out of online registration will be considered.
willing and potential organ donor; It is important to note the following points:
- Only about 1 percent of people die each year in situations where organ donation is permitted.
- Organ donation will only take place with the consent (consent) of the family.
The core message to the public regarding organ donation remains: “Don't leave your loved ones in doubt.” An organ donation card can be used to start a discussion with patients and their families, so they know about the decision to donate in advance . Healthcare workers are also encouraged to talk to their loved ones and share their personal wishes.
Future developments
Looking back at this year's successful Organ Donation Awareness Week campaign (20th to 27th April 2024), organized by IKA in collaboration with Organ Donation and Transplantation Ireland, we look back at how the public responded to the topic of organ donation. It is worth paying attention to whether they are actively involved in IKA volunteers and their social media.
However, two months after the passage of the Human Tissue Act, there are still significant uncertainties regarding current practices in organ donation for transplantation and how the act will ultimately impact the public. Confusion continues. Many are based on the mistaken assumption that the provisions of the Act are already in force. IKA believes that strong public education programs are essential. National messaging needs to be supported by community-based information programs.
As a community-based organization with over 45 years' experience in promoting organ donation, IKA is well-resourced and plays a vital role in promoting organ donation, working in partnership with Government and the HSE. We have already gained the trust of the people. Continuing public education programs.
Such programs are essential to ensure that everyone understands what opt-out registration means and how it works before it is officially introduced. Similarly, clear messages are needed about other provisions, such as how altruistic kidney donation will work and the significant preparations to ensure how it works in practice.
Figure 3:2023 dialysis/kidney transplant statistics
Figure 4: Main impacts on organ donation
conclusion
While the passage of this bill on February 28, 2024 was historic, it is not the end of the story regarding organ donation for transplantation. It's just the end of a chapter. The next chapter contains the initiation of the relevant parts of the law, and appropriate resources must be allocated to ensure that changes to the law are meaningful.
Health Minister Stephen Donnelly was clearly pleased to announce the passing of the bill, pledging to increase funding by €1.6 million in 2024 for organ donation and transplant services.
