Natalie Clark reflects on winning an Andrew Paris Memorial Fellowship.

My current role within organ donation and transplantation is research-based. I currently work as a Research Project Manager at the Academic Centre for Surgery (ACeS) within South Tees Hospitals NHS Foundation Trust and I am a registered Practitioner Health Psychologist with the Health & Care Professions Council (HCPC).

I completed my MSc dissertation on the Attitudes to Organ Donor Registration in England Under Opt-Out Legislation in 2018/19. Since joining the NHS Trust in 2019, I have worked with a team including Caroline Wroe (Consultant Nephrologist), Dorothy (Dot) Coe (qualitative researcher) and Hannah Gillespie (Academic Specialist Trainee in Renal Medicine) on a series of projects. These projects have focused on improving awareness, support and knowledge of organ donation within the wider NHS workforce, not just those who have direct involvement in organ donation and transplantation.

Despite implementation of the opt-out legislation across the UK, organ donation and transplant rates have not progressed as hoped in the UK. The number of patients currently waiting for an organ transplant far exceeds the number of organs available. The latest activity report by NHSBT 2024/25 states 8,096 patients are currently waiting, the highest number of patients waiting in 15-years. Consent rates have also failed to recover beyond pre-pandemic levels with 173 families overruling their loved one’s decision to be a donor. This illustrates the need to promote ongoing positive communications and normalise discussions about organ donation with families and within our communities.

NHS England is one of the biggest employers in Europe, with over 1.5 million employees and the most ethnically diverse. Our projects have demonstrated how we can use NHS staff to become organ donor advocates and lead positive conversations with their colleagues, families, and friends which will ultimately extend into their communities. Through the projects, we have shown NHS staff to be more aware and supportive of organ donation and the recent legislative change and more likely to have taken positive action (e.g., opted-in, had conversations with families). They also recognise the importance of having conversations about their organ donor decision with families and friends.

The Spanish Model of Organ Donation is globally considered as the “gold standard” for organ donation and transplantation. It has been embedded and normalised within healthcare settings and society. Learning how Spain has achieved this would enable effective adaptation of effective practices in the UK.

During this fellowship, we plan to collaborate with the University of Granada due to their research experience focusing on public attitudes, consent processes and sociocultural perceptions of organ donation. We will gain valuable insights into the ethical and societal dimensions of the Spanish Model of Organ Donation and the related systems supporting the model. Additionally, we will engage with the ONT in Madrid, facilitated by the University to observe and gain a comprehensive understanding of how organ donation is operationalised within healthcare settings. This dual collaboration will provide a holistic overview of the Spanish Model.

This visit will play a pivotal role in informing the next phase of our project, focusing on the development of educational resources, further aiming to support and promote positive conversations of organ donation amongst NHS staff. We will have developed a greater understanding and be able to incorporate culturally informed insights into how organ donation is discussed and understood within diverse communities. Our observations from the ONT will allow us to observe best practices in the implementation of normalising organ donation within healthcare settings, staff communications, family engagement and consent processes. This will further inform the creation of appropriate educational materials for NHS staff, ensuring that they are grounded both in research and in real-world practice, as well as addressing any gaps in knowledge NHS staff have identified in organ donation and the opt-out legislation.