Organ donation
other countries, national ethical guidance will be essential to support safe and consistent practice in this sensitive area. Most importantly, during the development
of the Report, donor families highlighted repeatedly that on the worst day of their life, a confident and compassionate clinical approach does not make things harder – it can actually make them just that bit better. Where a person has registered an expressed
decision to donate, that decision should carry real weight. Family over-rides of opt-in registrations continue to result in significant loss of organs available for transplant. International experience shows that enforcing individual consent does not erode public trust. Clinical staff often fear conflict with donor families and therefore may abandon discussions too readily but failing to honour autonomy risks undermining confidence in the donation system itself.
Donation pathways have become unnecessarily complex. Families may be asked hundreds of questions during consent and assessment, often at the most distressing moment of their lives. Many of those who shared their experiences describe this as intrusive and overwhelming. Some even reported that this part of the donation process was harmful to their grief. Simplification is not about cutting corners; it’s about focusing on what genuinely matters
for safety, consent and dignity. Streamlining language, forms and processes - while allowing families time and space to come to terms with the situation will improve both experience and outcomes. Ongoing support for donor families, including through partnerships with voluntary and charitable organisations, should be considered part of donation care, not an optional add-on.
Donation is a multidisciplinary skill, and
training must reflect this reality. MDT training for organ donation - not just for clinicians and intensivists, but for nurses, SNODs and wider ICU teams - should be standard practice. Teams that work together should train together. Performance metrics such as consent rates,
neurological death testing rates and donor family experience should be visible at hospital and board level. Where donation activity is not meaningfully reviewed, missed opportunities will persist.
Visibility will inevitably drive accountability and improvement. Organ donation will not become expected through general awareness and policy alone. It becomes expected when clinicians expect it of themselves and their teams. This requires leadership:
l To identify donation potential proactively; l To embed donation expertise within routine end-of-life care;
l To approach families about the possibility
or organ donation with confidence and compassion;
l To place patients’ own decisions at the centre of end-of-life care.
These actions are practical, evidence-based and achievable. The responsibility to deliver them now lies with all of us. Lives depend on it. CSJ
About the authors
Professor John Forsythe OBE was a consultant transplant surgeon and former Medical Director for Organ Donation and Transplantation in the UK. He has held senior leadership roles across transplantation, donation ethics and national service development, and was a key contributor to the implementation of the Organ Donation Taskforce recommendations. He has held many professional committee appointments and is a Past President of the British Transplantation Society and the European Society of Organ Transplantation
Donation pathways have become unnecessarily complex. Families may be asked hundreds of questions during consent and assessment, often at the most distressing moment of their lives.
24
www.clinicalservicesjournal.com I May 2026
Dr Gail Miflin OBE is NHS Blood and Transplant’s Chief Medical Officer. She was awarded an OBE in the 2025 New Years Honours List for her services to blood and plasma. She has worked in senior clinical and advisory roles and in her time at NHS Blood and Transplant, has led groundbreaking research into new treatments that are saving and improving lives and tackling health inequalities.
Stephen -
stock.adobe.com
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60
