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How to get through the MRCGP orals without stress

MRCGP orals are looming. In two 20-minute exams you will be asked to talk about five topics, spending about four minutes on each. Pulse has spoken to GP tutors and registrars and distilled their advice into simple points on the clinical and ethical dimensions in

each subject.

So tell me about organ donation and general practice

lFor the year April 2003 to April 2004 there were 2,854 transplant operations from 1,229 organ donors.

lHowever, as of May 2004, 5,737 people are awaiting transplants.

lThe UK has an opting-in system (a wish must be expressed to become a donor). However, only 19 per cent of the UK public is registered, despite 90 per cent supporting the principle of organ donation1.

lSpain and Austria have an opting-out system.

lThe BMA has called for an opt-out system to be adopted in UK2.

lThe RCGP position statement3 'makes

the assumption that most of those who

read [them] agree that organ

transplantation is beneficial', the grounds for this may relate to:

•Beneficence, patients who would

otherwise die or be severely disabled.

•Non-maleficence as the donor is dead

lLive donors present a particular problem. There are multiple conflicts between:

•Autonomy of the individual to do what they

will with their body (including selling organs

but illegal in UK).

•Beneficence to the person receiving the

transplant (283 extra donors).

•Non-maleficence to the donor, as the

procedure inevitably causes them harm.

lThe Human Organ Transplants Act 1989 limits donations to strangers but allows donations to genetically linked persons.

lUnrelated Live Transplant Regulatory Authority (ULTRA) considers requests to strangers (usually spouse or partner).

Autonomy of a dead donor

lIn the UK relatives may withhold consent for the organs to be taken.

lHuman Tissues Act 1961 puts the hospital administrative officer in lawful possession of the body.

lFamily refusal rates may be up to 30 per cent4

lFew surgeons would go against a family refusal on the grounds of worsening their grief, despite the expressed wishes of the deceased.

GP roles

lGPs have specific roles that can be divided into several levels:

Micro (consultation) level

lProviding information to allay patients' fears

on issues such as:

•Concept of 'brain stem death'.

•Maintenance of those who are brain stem

dead.

•Use of full anaesthesia during removal of

organs (there is technically easier surgery,

for example use of muscle relaxant).

lNone of the UK's major religions have a fundamental objection to donation.

lSouth Asian community (4 per cent of population) represent 14 per cent of kidney waiting lists.

lThere is a specific South Asian Organ Donation Campaign5

Meso level (practice)

lIncreasing donor numbers.

lEncourage the use of the 'donor' section of the new patient form.

lProvide and advertise donor cards in the surgery, but this could prejudice the initial doctor/patient contact.

lEffective medical practice to reduce the numbers of people with disease that may eventually require transplant.

Macro (governmental/college) level

lBe aware of national campaigns.

l'Leave more than Memories' campaign that ran from April to March 2004 in conjunction with the DVLA.

lRCGP position statement March 200.

lBMA Transplant Partnership.

lNew legislation proposed in Queen's Speech 2003.

References

1 NHS UK Transplant and DVLA press release March 10, 2004

2 Organ donation in the 21st century – time for a consolidated approach www.bma.org.uk (search under transplant)

3 Organ donation – an outline for GPs. Dr Ann Orme-Smith March 2002 www.rcgp.org.uk/corporate/organ_donation.asp

4 Gore et al. BMJ 1989 (1193)

5 NHS UK Transplant Winter 2003 bulletin www.uktransplant.org.uk/newsroom/bulletin/

(search under archive bulletins, bulletin 49, winter 2003)

Rob Wheatley is a registrar at Bulford Camp army barracks in Salisbury, Wiltshire

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