Policy actions  2 of 4

Organ and tissue donation and transplantation

At any one time, due to a shortage of organs, more than 500 people in Scotland are waiting for an organ to become available to give them the transplant they desperately need. 

Organ and tissue donation can greatly enhance or save lives. Over 50% of the Scottish population have joined the NHS Organ Donor Register. However people are still dying every day waiting on a transplant and the more people that record their donation decision on the  NHS Organ Donor Register, the more lives that can be saved.

Only 1% of people die in a way that makes organ donation possible, so every opportunity for donation is very precious.  Organ and tissue donation is a personal decision and everyone has a choice about whether or not they want to donate.

Our aim is to increase organ donation and transplantation rates in Scotland and to ensure that as many people in Scotland receive the life-saving or life-changing transplants that they need.  

Donation and Transplantation Plan for Scotland: 2021 to 2026

The Donation and Transplantation Plan for Scotland: 2021-2026 was published in March 2021.

The Plan has been developed with the members of the Scottish Donation and Transplant Group (SDTG).  In considering actions for inclusion, the group agreed that the plan should focus on those priorities which will or are likely to:

  • Increase organ and tissue transplantation and improve access to transplantation for patients; and
  • Improve the outcomes from transplantation.

It covers recommendations in seven priority areas:

  • Implementation and evaluation of the Human Tissue (Authorisation) (Scotland) Act 2019;
  • Increasing organ transplantation, including through novel technologies;
  • Reducing missed referrals and other missed opportunities for deceased organ and tissue donation;
  • Increasing living donation and reducing the wait for a kidney transplant, with a focus on living donation being the first option patients should consider;
  • Improving transplant recipient support and aftercare;
  • Research and innovation; and
  • Public health improvement, seeking to reduce organ failure over the long term.

An Equality Impact Assessment (EQIA) has been carried out to assess the impact of the Donation and Transplantation Plan for Scotland: 2021-26.

Novel technologies

The Scottish Government aims to support the use of novel technologies to help both increase the numbers of organs which can be transplanted and improve the function of transplanted organs.

In particular, we are working with NHS Blood and Transplant to support the Edinburgh transplant team to use Normothermic Regional Perfusion (NRP) when they are removing a donor’s abdominal organs after death.  NRP helps improve the quality of organs and allows time for surgeons to assess them to ensure they are sufficiently safe to transplant. Evidence shows that NRP helps increase the number of livers in particular that can be transplanted and also reduces the proportion of patients who suffer complications or whose transplant fails.

From 2020, we increased funding for NRP in Scotland to over £80,000 to help increase its use.  This should enable more patients in Scotland to benefit from a transplant, particularly as transplant services are recovering following the impacts of COVID-19.

Human Tissue (Authorisation) (Scotland) Act 2019

The Human Tissue (Authorisation) (Scotland) Act 2019, which provides for an opt out system of organ and tissue donation, gained Royal Assent in July 2019.  The new system came into force on 26 March 2021.  It will apply to most adults who are resident in Scotland, however it does not apply to certain groups of people or if donation would be against your views. The 2019 Act amends the  previous opt in system of authorisation in the Human Tissue (Scotland) Act 2006.

Under the opt out system, all adults aged 16 years and over will be considered to be willing to donate their organs and tissue when they die, unless they choose to opt out. This is subject to the safeguards in the Act which seek to ensure that donation will not go ahead if the person would not have wanted it to.

You still have a choice if you want to be a donor or not when you die. Whatever you decide, share your decision with family and friends, as they will still be involved in the donation process so it’s important you let them know what you have decided, so they know what you would want to happen.

As part of the donation process certain medical tests and procedures may be carried out before your death. If you do not record a donation decision it will mean that you agree to these medical tests and procedures.  Specialist nurses will speak to family members before these take place. Find out more about what these medical tests and procedures involve.

Public information has been provided about the opt out system and what choices people have, including a leaflet to every household in Scotland. For more information about the opt out system or to record your donation decision on the NHS Organ Donor Register visit: www.organdonationscotland.org

The change in the law follows a consultation on ways of increasing the numbers of successful organ and tissue donations and transplantations, including proposals to introduce an opt out system of organ and tissue donation. We published the analysis of the responses to this consultation in June 2017. This showed that 82% of the respondents supported the move to an opt out system.

Living kidney donation 

Living kidney donation is an exceptional gift that can transform the life of someone on the transplant waiting list.

Our aim is to reduce waiting times for those in need of a kidney transplant by ensuring timely access and equity of access to pre-emptive live donor kidney transplantation.

Living kidney donation can lead to better outcomes for patients and we want to encourage those who need a kidney transplant to consider and explore options for a living donor transplant as their first transplant. One donor can trigger a ‘chain’ of transplants through the UK Living Kidney Sharing Scheme, meaning up to three people can receive a transplant as part of one person’s gift.

The policy on reimbursement of living donor expenses sets out information for healthcare professionals in Scotland about the principles and processes that underpin payment of expenses to living donors.

A Living Kidney Donation and Transplantation Information Pack has been developed to provide healthcare professionals with a detailed overview of the process in Scotland.

Scottish Donation and Transplant Group

We formed the Scottish Donation and Transplant Group (SDTG) in 2001 to provide a regular forum for representatives of the donation and transplant communities in Scotland.

In March 2021, we published an updated agreement between the Crown Office and Procurator Fiscal Service and the Scottish Donation and Transplant Group in regard to organ and tissue donation.

Paediatric and neonatal organ and tissue donation

We worked with clinicians, nurses, midwives, charities, family members and other stakeholders to provide the following guidance on how to enable donation in cases where a baby or child has sadly died or is expected to die:  

Commissioning transplantation to 2020

All solid organ transplant services are nationally commissioned by National Services Division (NSD) which is part of NHS National Services Scotland.  NSD’s Commissioning Transplantation to 2020 report sets out current plans for organ transplantation services for Scottish residents.