Health, University of Wales, Bangor. Martyn Bradbury ... Carol Dealey, Research Fellow, University Hospital ... Clare Morris, Tissue Viability Advisor, North East.
Comment
Editorial Board Russell Ashmore, Lecturer in Mental Health Nursing, University of Sheffield Steve Ashurst, Critical Care Nurse Lecturer, Maelor Hospital, Wrexham Jill Aylott, Lecturer/Researcher, Learning Disabilities, Sheffield Hallam University Christopher Barber Ruhi Behi, Head of School, Nursing, Midwifery & Health, University of Wales, Bangor Martyn Bradbury, Senior Lecturer, Institute of Health Studies, University of Plymouth John Cutcliffe, 'David G Braithwaite' Professor of Nursing, University of Texas (Tyler); Adjunct Professor of Psychiatric Nursing, SCISN, Vancouver, Canada Sue Davies, Senior Lecturer in Nursing, University of Sheffield Carol Dealey, Research Fellow, University Hospital Birmingham NHS Trust Bridgit Dimond, Emeritus Professor, University of Glamorgan Willie Doherty, CNS Continence Care, Park Drive Health Centre, Baldock, Hertfordshire Kimmy Eldridge, Deputy Head of Department and Director, Health and Human Sciences, University of Essex Andy Farrington, Assistant Head of Nursing, Counselling and Psychotherapy, University of Derby Harry Field, Mental Health Act Commissioner Sarah Fisher, Director of Nursing and Development, Moorfields Eye Hospital NHS Trust, London Jane Fox, Senior Quality Assurance Coordinator (North), Skills for Health Alan Glasper, Professor of Child Health Nursing, University of Southampton Angela Grainger, Assistant Director of Nursing, King’s College Hospital NHS Trust, London Elizabeth Hanson, Senior Lecturer, Department of Nursing, University of Gothenburg Jo Hesketh, Chief Executive, Shropshire Crossroads Helen Holder, Senior Lecturer, Nursing Studies, University of Central England Phillip Hufton, Independent Nursing Consultant John Keady, Professor of Admiral Nursing, Northumbria University, Newcastle-upon-Tyne Lesley Lowes, Research Fellow/Practitioner Cardiff University/University Hospital of Wales Elizabeth McElkerney, Directorate Manager, Women & Child Health, Ulster Community & Hospitals Trust Richard McMahon, Director of Clinical Governance, NHS Professionals Andrew McVicar, Director of Research, Anglia Polytechnic University, Essex Clare Morris, Tissue Viability Advisor, North East Wales NHS Trust Mervyn Morris, Director, Centre for Mental Health Policy, University of Central England Cyril Murray, Senior Lecturer, University of Salford Aru Narayanasamy, Senior Health Lecturer, University of Nottingham Mike Nolan, Professor of Gerontological Nursing, University of Sheffield Ann Norman, Seconded to the Prison Service/NHS Taskforce Joy Notter, Professor, Community Health Care Studies, University of Central England; Lecturer, Health and Welfare, Academie Gezondheidszorg, The Netherlands Lynn Parker, Independent Educational Adviser, Infection Control, Sheffield Hilary Paniagua, Senior Lecturer, School of Nursing & Midwifery, University of Wolverhampton Ian Peate, Associate Head of School, Health & Human Sciences, University of Hertfordshire Bernadette Porter, Nurse Consultant, Multiple Sclerosis, National Hospital for Neurology and Neurosurgery, UCLH NHS Trust Karen Rea, Barrister, London Vicky Robinson, Consultant Nurse, St Christopher’s Hospice, London Antony Sheehan, Joint Head of Mental Health Services, NHS Executive, West Midlands, Birmingham Pam Smith, Professor of Nurse Education and Director of the Centre for Research in Nursing Midwifery Education, University of Surrey John Tingle, HRS Reader in Health Law, Nottingham Law School, Nottingham Trent University Jo Trim, Nurse Adviser, Birmingham New Hospitals Project Bernice West, Academic Director, School of Nursing and Midwifery, Robert Gordon University, Aberdeen John Wilkinson, RCN Officer, Royal College of Nursing, Eastern Region Kate Williams, Research Fellow in Nursing, University of Leicester Jo Wilson, Director, Wilson Associates, Newcastleupon-Tyne Sue Woodward, Lecturer, Specialist and Palliative Care, Florence Nightingale School of Nursing and Midwifery, King's College London
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Human Tissue Act 2004 comes into force
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urses have a key role to play in implementing the requirements of the Human Tissue Act 2004 (HT Act), which comes into force on 1 September 2006. From that date, the Human Tissue Authority (HTA) will be responsible for licensing a number of activities and will also be responsible for approving transplantation of organs, bone marrow and stem cells from living donors.This article aims to inform nurses of what the changes will mean for their practice.
Consent The fundamental principle underpinning the work of the HTA is consent. The HTA aims to foster an environment of trust in which patients are able to have confidence that their wishes will be respected, and that scientific and medical developments can flourish. Consent must be valid for certain procedures, such as post-mortem examinations (except coroners post-mortems), to be carried out. Other activities, such as taking tissues from the living for diagnosis and treatment, or for teaching, audit and quality control, fall under common law consent to treatment rather than the HT Act. Each Trust should have a well-publicized policy for obtaining consent, be it under common law or the HT Act; and nurses involved in consents for surgical procedures or in taking samples, such as blood, need to be aware of this so that they can advise patients accordingly. The HTA has published its Code of Practice on consent and will shortly publish model consent forms which can be adapted for local use.
Living donor transplantation From 1 September 2006, the HTA will regulate, across the UK, the donation of all solid organ transplants, allogenic bone marrow and peripheral blood stem cells for transplantation from living donors, whether or not the donor is related to the recipient. The HTA will also be responsible for approving non-directed altruistic and paired/pooled donations, which provide additional opportunities for patients to benefit from transplants. More than 100 independent assessors (IAs) have been trained and accredited by the HTA to assess applications for all living-donor solid organ transplants. They will act as representatives of the HTA and as advocates for the donor. More complex cases will be referred to an HTA panel. It is recognized that there have been concerns that the new approval processes will introduce delay and impact on the activities of living-donor transplantation programmes. While maximum timelines have been agreed — and these will be no longer than the turn-
around times currently involving approval of unrelated living donation of organs — it will be up to everyone involved in preparing donors and recipients for a living-donor transplant, to be as organized as possible in their working practices to minimize this risk. The HTA has been working closely with NHS Blood and Transplant (UK Transplant and National Blood Service) to make the transition as seamless as possible. A comprehensive guide for transplant teams and IAs will be circulated to all transplant units, referring hospitals and IAs before 1 September 2006 – and made available on the HTA website (www.hta.gov.uk).
Use of tissues and organs after death Organs and tissues from the deceased are widely used, with full consent, for a variety of purposes in addition to transplants. There are, for example, a number of brain banks across the country, and many universities have ongoing projects where tissues from the deceased are routinely used, such as the donation of lower limbs for research into car crash injuries. Postmortem examination is the final act of diagnosis, and is an important tool in audit, clinical governance, teaching and extending the field of medical knowledge. The HT Act (which covers England, Northern Ireland and Wales) represents a fundamental change in that a patient can state their wishes about what happens to their body after death, and can also nominate a representative to make decisions on their behalf. From 1 September 2006, the wishes of the deceased legally take precedence over those of the family. In addition, the HT Act allows cold perfusion – a technique used to preserve organs following death – until the wishes of the deceased are known (or, if appropriate, until the consent of the family has been given). Nurses will be at the forefront of advising patients about nominated representatives and how to make their wishes known, as well as in communicating with coroners about cold perfusion. A person can make their wishes known by joining the NHS Organ Donor Register, carrying a donor card, or through discussion with family members or clinical staff. When the family or those close to the deceased person object to a procedure, they should be encouraged to accept the wishes of the deceased and made aware that there is no legal right to veto or BJN overrule them.
Ruth Musson Pathology Specialist Nurse, Nottingham University Hospital
Lisa Burnapp Consultant Nurse, Guy’s & St Thomas’s NHS Foundation Trust
British Journal of Nursing, 2006, Vol 15, No 15
2/8/06 14:55:40
