Organ donation
experts underlined the need for a culture of trust within the clinical team and that that best practice is followed every time; for the family, honouring the wishes of the potential donor, and for the delivery of good quality care. Further, evidence was presented that while the new donor legislation (now in force in all parts of the UK) is very useful as a strong indicator of overall community and organisational support for donation (indeed the ‘default’ position), this legislative drive should not be used at the bedside in a tragic situation of loss – such an approach can be a disincentive to thinking mainly about the values and desires of a loved one. A better patient and family framework is a
best-interests approach, familiar to intensive care, which is both ethically robust and emotionally supportive: what would this person have wanted, given who they were? Testing rates using neurological criteria, for the diagnosis of death are now at their lowest in 15 years. This decline directly reduces the
A donor family’s perspective…
One of those families who helped shape the report was Jess Cooper from Tadcaster in North Yorkshire. Her husband Paul died in a car accident near Harrogate in 2018 aged 35, and when Jess was told there was nothing more doctors could do to save Paul’s life, she didn’t hesitate at him becoming an organ donor. Jess said: “Paul was the kind of person who would do
anything for anyone, so when the time came, there was no hesitation in saying yes to organ donation. Although we’d never had a serious conversation about it, we once joked about it, and that stayed with me. In the darkest moment of my life, knowing the sort of person Paul was made the decision clear. I find so much comfort in knowing that people are alive today because of him. Their families still get
to see them, speak to them, laugh with them and that brings me enormous pride. Knowing Paul didn’t die in vain has helped me navigate my grief and explain to our children that their daddy is a real-life superhero. “Death is something we don’t like to talk about with the people we love, because we can’t bear to imagine losing them. But when that moment comes, families are faced with overwhelming pressure and life-changing decisions at the worst time of their lives. That’s why it’s so important to have these conversations while you’re alive. Please talk to your family about organ donation, whether it’s something you want to do or not. If it is, make sure you register your decision, so your loved ones can be certain they are honouring what you truly wanted.”
number of donors after brain death (DBD) and cannot be explained by case-mix alone. Barriers are thought to include increasing clinical complexity, as well as societal and legal challenge to neurological criteria, leading to hesitancy in their interpretation and application. Recent endorsement by the UK Chief Medical Officers of updated national guidance on the diagnosis of death using neurological criteria reinforces a critical point: confirming death is a medical responsibility, not a donation decision. In discussions, the four CMOs have underlined this point. Clinicians practise confidently when guidance
is clear and professionally owned. Gaps in national end-of-life care guidance, particularly in donation after circulatory death (DCD), continue to create inconsistency in practice. In countries such as Spain and France,
standardised protocols for medication and sedation during withdrawal of life-sustaining treatment apply regardless of donation status. In the UK, variation persists, leaving clinicians uncertain and families vulnerable to mixed messages. The concern is not that excessive end-of-life medication is routinely administered. Rather, concern about potential scrutiny or misinterpretation may lead to overly cautious prescribing, with the risk of suboptimal symptom control. Updated national guidance, led by relevant
professional bodies, would reassure clinicians that end-of-life actions supporting donation are clinically, ethically and legally sound. This confidence is essential if donation is to become expected rather than exceptional. Between 2009-2016 there was a UK Donation
Ethics Committee that gave guidance in these difficult situations where objective, independent advice was seen to be helpful. During this period donation rates rapidly improved as complex ethical issues were considered and trusted guidance delivered. The ODJWG recommends the re-institution of this body. If the UK is to consider donation commencing or occurring outside an ICU setting, as is established practice in many
May 2026 I
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