Donation of kidneys. Medical Services Study Group of the Royal College of Physicians.

A survey of deaths from medical causes among hospital inpatients aged under 50 years in three health regions provided details of 1168 such deaths not caused by renal failure. Kidneys for transplantation were obtained from only 20 of these patients. In another 18 cases permission was refused or donation was impracticable. Ninety-eight of the deaths were due to subarachnoid haemorrhage and 38 to primary cerebral tumour, yet kidneys were obtained from only 11 and one of these patients respectively. Patients dying from subarachnoid haemorrhage are particularly suitable for donating their kidneys, but there is still a shortage of kidneys for transplantation because they are not harvested efficiently. Doctors seem to be reluctant to ask relatives' permission to remove kidneys, and the arrangement of a donation is time consuming. Because transplant surgery is recognised as a specialist sphere, surgeons in other specialties may be reluctant to remove kidneys and come to rely on one transplant team covering a wide area. In an area such as Grampian, where a small population is served by one hospital containing all the major units, including accident and emergency and renal departments, it may be easier to arrange prompt donation and transplantation.