As SingHealth Transplant looks at expanding and improving its programmes and services, increasing organ donation rates remains a challenge.

Singapore's organ donation rate at 6.5 per million population lags behind other developed countries like the UK which has a donation rate of 20 per million population. Dr Dale Gardiner, Deputy National Clinical Lead for Organ Donation, NHS Blood and Transplant for the UK, shares how they overcame the challenges faced in efforts to improve organ donation rates.

There was a time when Dr Gardiner had his doubts about organ donation. He asked many questions: How do we know when someone is dead after the heart stops? Isn't there a conflict of interest, moving someone from care to donation?

Dr Dale Gardiner (right) gave a talk on the topic "How the UK overcame the ethical, legal and professional challenges in organ donation" at SingHealth Academic Hour, 13 october 2016. Director of SingHealth Transplant Assoc Prof William Hwang (left) moderated the Q&A session.

Nine years later, Dr Gardiner is the Deputy National Clinical Lead for Organ Donation, National Health Services (NHS) Blood and Transplant for the United Kingdom (UK). The questions he asked were important, and he got good responses and advice that convinced him that facilitating organ donation is a privilege.

Dr Gardiner described: "It is the most humbling moment of my work in intensive care. To see families in the midst of their grief, look beyond themselves to others, and say that simple word: yes."

UK has multiple publications on the framework of practice with regards to organ donation and its ethical, legal and professional implications.

It did not happen overnight. Organ donation is an emotional topic with a plethora of barriers and concerns, but the UK medical community has proven that the healthcare community can rise above them.

"We have learnt that the problem lies not with the public, but with ourselves, as doctors and nurses," said Dr Gardiner.

He shared that the percentage of people agreeing to organ donation is still the same. The key to higher numbers of consent was simply to ask more people. "We have the intensive care and emergency departments to thank. They have approached 23 percent more families of potential donors after brain death, and 456 percent more families of potential donors after cardiac death in the last two years," Dr Gardiner said.

"We have simply been brave and asked more people."

Talking to family members is more important than having the donor card in the UK – families will remember the conversations. It's a telling shift in attitudes as 57 percent of UK organ donors in 2015/16 were not on the NHS Organ Donor register.

"… And if their values and wishes at the end of life is to help others through donation, then you got to give it a chance and make that happen."
- Dr Dale Gardiner,  Deputy National Clinical Lead for Organ Donation, NHS Blood and Transplant for the UK

Dr Gardiner laid bare the facts: "We realised: Organ donation is difficult work. We know now that every family has unique dynamics, and to expect the unexpected. We've learnt to offer the choice to everyone."

The model for UK organ donation is such: In every intensive care unit in the country is an 'embedded' Specialist Nurse for Organ Donation, a Clinical Lead for Organ Donation and a Non-clinical Donation Committee Chair. There are now 190 teams across the country that facilitate organ donation.

Dr Gardiner said, "Too often, doctors and nurses in intensive care forget who we are working for. It is our duty within our patient-doctor relationships to look beyond the physiology, anatomy and pathology of the patient, and support the patient's values, wishes, beliefs and desires. And if their values and wishes at the end of life is to help others through donation, then you got to give it a chance and make that happen."

In 2009, UK Legal Guidance for Donation after Circulatory Death was published. It sheds light that the desire to donate gives clinicians authority to take reasonable steps to ensure donation occurs.

"Too often with organ donation, we place such emphasis on the receiving patients that we forget who the giver is. It is a gift the patient wanted to give, and we should not stop that gift from happening," Dr Gardiner shared.

"We are the middlemen of that gift, and we should not take away the patient's and his family's choice to give that gift."