Weiyi Tan reflects on her Medawar Medal winning research project.

How ethically comfortable do you think the general population is with uncontrolled donation after circulatory death (uDCD)? How ethically comfortable are you personally with uDCD?

My involvement with this project stemmed from an interest in medical ethics and a curiosity to learn more about organ donation – little did I know it would lead to presenting in front of 1000 people at the Medawar Medal session! Although as nerve-wracking as anticipated, I thoroughly enjoyed the presentation and was excited to share these exciting results with a room full of people who are actually subject experts.

Organ donation following sudden, irreversible out-of-hospital cardiac arrest – uDCD – is currently practiced in several countries across Europe with excellent outcomes. However, there exist logistical and ethical challenges to introduce a uDCD programme in the UK, including a lack of public knowledge and engagement. Therefore, through a questionnaire study recruiting 505 participants we set out to explore public knowledge and acceptance of different forms of organ donation practice, specifically focussing on uDCD.

Overall, support for all organ donation scenarios was consistently high: those likely/definitely willing to donate were 73% for DBD (donation after brain death), 67% in cDCD (donation after circulatory death), and 73% for uDCD. Notably, there was no difference in support for uDCD compared with DBD – which already happens. Furthermore, 96% believed uDCD already happens in the UK. Qualitative analysis revealed altruism as the primary driver – “organ donation after death is a profound act of altruism, offering the possibility to save or significantly improve the lives of others. The idea that even in death, a person can contribute to the well-being of others is a powerful motivator for me” – as well as providing comfort for the bereaved.

In uDCD, the limited timeframe can result in a tension between optimising the chance to donate and obtaining family consent/maintaining bodily integrity. Although some voiced concerns about cannulation, the majority decided it was most important to prioritise the former: “if I were the relative I’d be devastated if the chance to donate was missed just because in my absence no-one quite liked to do the necessary actions to make the choice possible”. Many noted the time constraint and recognised organ preservation techniques as not only acceptable, but helpful for the family: “it gives precious time to be able to have a discussion with the family in a sympathetic and caring manner. Allowing them time to grieve. The chances are the patient has already got lines and tubes attached so one more isn’t going to be any more invasive.”

Winning the award was an unexpected delight that has cemented a desire to pursue research in the future, with a new awareness of the tangible impact it can have. And rather than intimidating, my experience at the conference was extremely supportive – and I had the best mentors and cheerleaders in Zoe Fritz and Dominic Summers, thank you both!

And so, if we want to honour the wishes of potential donors and meet the desperate need for organs for transplantation, I leave you with a final question in the words of one of our PPI panel: are we letting the public down by not providing a uDCD programme in the UK?