Poe raul Modem biology sometimes rises dificult and controversial issvea, which floc the lives we lead and the envionment we liven. Ths column examines sch ehicel problems J The Human Tissue Authority Risuliton a heath meted wo ensue quay ad fet and oproec patents nd the publi. The Hisman ‘Trae Authority works to ensure that human dssues and onan are used safely for purposes such as research, patient ‘reaumeot and wansplatation ‘ema Tse Ogee val hes Have you consented to rea this Bloxcica Scevts Rem arte ‘OF course’ you might reply." readingitare’ But would this aya legal definton of consent? Four ets are requlted in the eyes of the a for You to provide valid conse Fist must be an ative decision ~ faltly eas that one because you have clearly made a decison to read Seco it needs to be voluntary — your rating should not be the result dares or coercion fom teicher of parents, oF even bec ou have been afeed a ead ® Third your choice (to ead) shoul be approprintely informed — you should know what it means to rea this article an any sks hat might De involved, pb ‘consent “rarplnttion Key words @) Chief executive of the Human Tissue Authority Alan Clamp explains how the HTA engages in debates about the ethical issues associated with research and treatments, and how we might increase the availability of organs for transplantation Finally you mast have the mental capacity to make a reasoned choice trea, Perhaps none ofthis is very contentious, Afterall it 8 simply reading an amticle in 4 magazine, But what i the consent being, Considered was to donate a kidney t0 a member of your fami? Or wo havea simple fof sour bone mares removed to produce 3 ‘medical eatment for someone elie! Orto donateourbady to medical aclence afer your death? These biethial iases require close extmination of valid consent. In England, Wales and Northean Ireland, the organisation responsible for ensuring that wall consent i in place fr these activites fsthe Haman Tseie Authority. ‘The Human Tissue Authority (BTA) ‘The HITA sas setup in 2005, following events in the 1990s when some hospitals removed and rained human ‘nga and ses without consent. At that tne, the main - eeCel 09, usd ll 4 Tosues e.g muse tue 4 organ eg. stomach 4 Organ yatem, 9, digestive stem Laxgetomplex Figure + Levels of organisation nthe human body purpose of the HTA was to ensure that valid consent i in place forthe removal, storage and use of human tissue and ‘organs Figure | shows the differen levels of organisation of Iiving material inthe human body that were covered by the authority at that time In 2007, the remit of the HTA was extended to cover the ality and safety of cll used to treat patients In 2012, ‘he HITA slo took on responsibilty for ensuring the quality and safety of organs for transplantation. The HTA now ‘regulates all organisations that remove, store and us issues fan organs for research, medical treatment, postmortem ‘sxaminatin, eatin and texining, and deploy in pic (ouch as in museums) {See Box 1). Its aso responsible for assessing and approving all orgin and bone martow donations from living people Regulation There ate laws to ensue that human tises an organs are sed safely and ethically, with proper consent. The HA it responsible formaking sre that these awe are met by setting standards tha must be followed to provide the publi with confidence in the system, “The HT Ticenses establishments that remove, sore and use human tissue, and inspects them to make sure that standards ae met If there are any shortfall that might compromise quality safe orethicl requirements, the TA ‘an compel an establishment to make improvements, oF + Treating patients wth prtcalr mesa condtions, 3 ents, * Tearing wt people whose xgnshave fed 3 hort eee "Tres people with tem cee for bod dards, ich 2 lesa «Using ell atures to reser causes nd tesment for late, sich as cater odes ef the rena ster. * Teaching stents about the human body and surg sil eine + Finding the cause of det hough port moran * pay pub; suchas exhib nd muscuns ee ed The HTA masta ident rating to gan, sues ad els to mataln improve the sly ar salety of humo thes wed fr tanplntton ed ptier tester. There ate wo types of neler sere odes rectors GAR), where waneplonatien rested inthe ‘tendon of deat or whee the redplet rte donor ded or ‘coprene fe testeing ordeal eonsequences Sere shee vere (SAB, which rine tht have the pot to ase ary othe above ‘apie of SAR ight be the acer tranamision of malignant elt ‘nan gon tangle tat retedin the ecpen developing care AN ftample ofan SAE woul beacontaminated cores, wbich a ipl 6 Sliican ut nat ued na pater. Organon and indus hve to ‘report SARe and SAEs tothe HUA The MTA thn ensres tat the xganition rele iestigtes the ince tls propre tps tener tt oes rot happen gan even removes licence and op its activites altlogeer. Any establishment ‘ha uss human tissues and cells fr patient teatment, including ongan {eansplanatien, hasan additional esponsibility 1a repo ‘erous adverse ‘evens and ‘serious adverse reactions to the HTA (eee Box 2) By acting as a watchdog, the HTA provides reassurance tous all about ‘the appropriate use of human material and that our wishes will he respected As 2 result the HTA hopes that more people wll donate seit tistes for ceatificand medial esearch, their organs for iraneplants, and thelr bodies for medial education and training. This will help healthcare toflourish inthe UX. Box? describes one ate of medial research — using stem cells hat segue by the HTA (Organ donation from the living When it comes to organs for uansplanaton, demand fr exceeds supply (Gee Bosocien Scrcts Reve VoL 25, No.1, pp. 32-37) In Europe there ‘re approximately ten deaths cvery day af people on che waiting lis for an ost cals an act dy have speciicroes hat canot be hanged, Fe ‘example heat rer eels fui pedals ls anc camot turn another ‘ype of cl, tem clare diferent because ey have the pote to deep bio rental yes. Thre is much extent about the potent erste ces o be sed 135 Yea i forthe bay, o Wes damaged or dseased tse. Recent ‘rouncemers inte med er cial tal uss els eat, {orm of bndness oe domsged eatin eet atk vit Sen els an aho be used reach, Fr expe sents have recent fwd tat he ecru that cases eos ca tur neous aster cel int sten ek Stem calls come om lz seurces and, depend the tg thy can pore vigorous ethical debate Some group or example, donot are wh {he deseucionc shuren enbyo cet stem els Othe source of stn ‘lsd net eva huran ends eek, edt sem cel rd duce Pepe stem cel ee Boe Seas ern Vl-24 No.4 22-25, Bono marrow cls are an angie adlt stem als tht cn develop sno lfleret peso ood cel Stem cll pest in a the Bren exverted int heart muscle Indeed phrpoton ste cals come fom inary {lsd a shin — winding the dock bad’ to reqroganne then io stm alt alors thet regan the aby tot it dierent cl pes. Fobra 2018Altruistic organ donations ise EeEReS ai & 8 ° ‘ongan Patients can expect to waitan average of 5-5 eats for 1 kidney from a deceased donor The clinical outcomes for patent receiving an ong fom slivingdanorarebetter than those for organs fom deceased donor. In he UK, living donors account for around half fof all donors and supply approvimately a third ofall Big Rise in Number of Living Organ Donors {in UK almost three-fold ity News tty 2013) (BBC e201) Altruistic donations: ' could save a life ~ and that's all that matters’ (tlh, er 00 ‘ear Figure 2_ Annual iving organ donators approved inthe UK 8 Inthe yar 202-13 there ware oer 100 non reed seit’ dey donation the UE cure have tw nes and, tau, ey bot se to be working OF cans with just or, so shuld! give ore any to serrone who needs more than me, poy eving fe? The usin ak meal when coredting th aight be «hat fry emg tine al Sheu aod dating tw otect met agne ftre iey ne? Mh the patty ef ts happening? What ae the rks of undergoing the pean to remove ‘neo yay? Be ing to tke these ks an Sa ‘th the apts? "ores te they? ft one of my ehikeen — no problem My we? Of couse My ster Yes. My faber? ‘Amos enitly —but he's ot geting ay younger an ‘want tlc the nan dt hon mht wold extend Erprove is uaty of fe Wa about ny stern ry css more stat ete What about rents? Al hese ‘af peepee and care abut But what bout pople Ton know? the answer ss es’ wkd Dec ‘ner-drected ato dnos. Hy ereer maybe penn on end ce — theo making Fgements about who fest "worhy’ needy? iy woul donate st someting that irk ought 0 oa pacing mpl under ars)” Meal it be cate people expect me to (paps ak of omcon)? ‘ipecting some sare revard na franca of couse, but erhapeenotonal nd nthe frm of incensed spect for my "eles ac Doe he desion ely hage on ber faced with ceumstances where dhe question aise fr ea | would ace éenaten does at mean shel make one? 1 hy woul ot donate? Clay ths where om the ‘moment 20 hy Havent donsted ad have ne meite ans to My ana for no that | keping ht pare” [ney neat or srsone ora tome, pede bloga eres eeneed Fac turer formation about the wor ofthe HUA epsinyurcomizogra Fora debate ate he mteducton of deere consent (ammesimes refered as opt-ut or pesumed coset or ‘organ cena Wes, which ef became in Wakes na ora bbccoukinewsikewales-pliics 23127751 The Achsshop of Vides speaks Ot agaist resumed worn bbecoakinewsik-wales-23137847 ‘Tee fold nceae m numberof atu organ donations ‘ra hing pple Proton a so stem calle ora be co kinewstheath- 2540374 transplanted organs. The HTA must ensure that these donors have the capacy to make important decisions, uodestand the rs involved, and that thete i no evidence of rewand, ‘coercion or dues, Tn the year 2011-12, the HTA approved 1214 living organ donations (se Figure 2), The vast majority (968) ‘were kines — the remainder were liver lobes, Nine oof ten were ‘directed! donations to specied family membere ‘or close finds, There were 39 caer of ‘ltrs’ kidney ozation, whee peopl were willing to donate a kidney but Jet hospitals choose the recipient en the basis of clinical ‘need, The numberof people wilingto donate abrusticallyis fncreasing year-on-year and asjustover 100 (including one ‘ae of donation of iver lobe) in 2012-13, Box 4 outlines some of the ethical ise involved ‘Current Chair ofthe HTA, Diana Warwick sid le arice cation aneasee gee el ns Topics for discussion + How important is consent? Bo you think it would be csbicallyaceptableto maximise the use ofhumatsues and ‘nga for lnc use ach a life saving transplantation) by ‘aking from deceased people without the nee for consent To increase the supply of organs for transplantation, hasbeen suggested that countries setup regulated ‘markets for organs, This might permit someone to tll a kidney to {health organisation, shih would then use that organ for someone on the waiting lit Does this pose any ethical problems! ES eet eek my revisiOn notes > Manage your own reision wth sep-y-spsunpor ‘rom exes Mike Boyle cc Frank Socheck! of bloga! processes ana tance, >» Raise your grades by appjing clei te scoured wih theo of deetons ava kay words > Improve your els a tacke specie cam qunstons ‘Quick gulzes » www. therevisienbutton.co.uk/ ‘myrevisionnotes eer 2014 my revision notes as BIOLOGy my reviston rot BiOLoGy File))>) 3 EDU