OU on the BBC: Inside The Ethics Committee - Transplant

Production team Charlotte is a young woman in her thirties. Since her kidneys failed a few years ago, she spends every night attached to a dialysis machine, which cleans the toxins from her blood. Dialysis is a life-line, but it’s by no means perfect. And her long term outlook is bleak. Doctors don’t expect her to be alive in a decade. Her only hope is a kidney transplant from a living donor.

But Charlotte is an extremely high risk patient. She could lose her life during the operation and the transplant team are very reluctant to operate on her. Charlotte’s husband, Robert, remembers her doctor saying "it would be a brave surgeon who would take a knife to your wife."

Charlotte suffers from a severe form of "sticky blood syndrome’" where life-threatening clots can form in her circulatory system at any time, causing anything from deep vein thrombosis to a stroke. Charlotte takes daily medication to thin her blood and reduce the chances of this happening. But it’s a balancing act - too thin and she can suffer a catastrophic bleed; and recently Charlotte only narrowly survived a brain haemorrhage.

To undergo a transplant operation, Charlotte would need to be taken off her medication in the hours beforehand, to reduce the risk of her bleeding to death on the table when the transplanted kidney is placed inside her. This would open up a window of opportunity for a blood clot that could kill her. Then there’s the risk of catastrophic bleeds as the doctors try to put her back on her medication and get the delicate balance between clotting and bleeding exactly right.

Then there is the risk to the donor kidney. Charlotte had lost her own kidneys to blood clots, and the risk of a donor kidney failing are considerable, both during and after the operation. Family members or a spouse could donate if found to be a tissue match. But is it ethical to put a healthy person under anaesthetic, and remove one of their kidneys, when it could easily fail once transplanted into Charlotte? Is this the best use of a precious resource?

One person close to Charlotte is found to be a perfect match. But, given that Charlotte so desperately needs this operation, how can the medical team be sure that s/he really wants to donate? How do you ensure that coercive forces are not at play? Can a living donor ever be truly altruistic?

If the operation goes ahead, Charlotte’s doctor wants to try out an experimental procedure to help reduce the risk of fatal blood clots during the operation itself. But it’s never been used in transplant operations before. When is it appropriate to use experimental procedures on patients? Does the high risk of the organ failing, or indeed Charlotte losing her life, make it more ethically acceptable?

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Inside The Ethics Committee in more depth: