2023/24 review: Supporting our licensed establishments to overcome challenges

We have a unique role as a regulator where we approve all cases of living organ donation in the UK when criteria – set out in legislation – are met. To make this decision, we need to be satisfied that:

• a donor has not been or will not be given a reward for their donation
• a donor has not been coerced or experienced duress to donate, and
• a donor has provided valid consent for the removal of their organ.

Number of approved living organ donations

In 2023/24, we approved 1,119 living organ donations. The number has steadily increased over the course of our strategy and continues to recover after the number of living organ donations reduced to 561 during 2020/21 due to the Covid-19 pandemic.

Of the 1,119 living organ donations we approved in 2023/24, the majority – 1,080 (96%) – were kidney donations, 38 (3%) were liver donations and 1 (1%) involved the donation of another organ.
 

In March 2023, a Nigerian senator, his wife and an accomplice were convicted of bringing a man to the UK to have his kidney removed and transplanted to their daughter. This case highlighted how the landscape of living organ donation has changed.

In response, we have taken steps to play our part in building awareness and detecting the trafficking of vulnerable people for their organs. This has involved strengthening aspects of the living donation approval process to evidence the relationship between a recipient and donor – for example, by working with the sector to clarify what is considered acceptable evidence, and no longer accepting unsupported affidavits as evidence of a claimed relationship.

We have also ensured all Independent Assessors (IAs; who interview donors and recipients to explore whether legislative requirements are met on our behalf) have the information and training they need to detect human trafficking. We have done this by ensuring IAs receive mandatory refresher training to improve their knowledge and understanding of the relevant signs and indicators of human trafficking. Our guidance for IAs and clinical teams has also been updated so that it is easier to navigate.

Given we participate in the latter stages of living organ donation, we collaborated on this issue with organisations and government departments. By proactively engaging with key stakeholders, we have been able to put measures in place to detect the trafficking of vulnerable people earlier in the living organ donation process and ensure a wider system impact. An example of this includes working with UK Visas and Immigration to raise awareness of visa applications that could involve human trafficking for organ transplantation. It has also resulted in us receiving notifications of the number of relevant approved and rejected visa applications (to help ascertain the scale of the problem).

To share learning and understanding of the threat of human trafficking for organ removal, we hosted a roundtable discussion with the relevant agencies. This included NHSBT, police forces, the National Crime Agency and government departments. We have also raised awareness of the threat by presenting at events such as a human trafficking conference, which was organised and attended by the police.

To identify cases earlier in the living organ donation process, there is a need for clinical teams to have a level of professional scepticism. In a bid to assist the detection of human transplant-related crimes, government laid the Human Tissue Act (Supply of Information about Transplants) Regulations 2024 before Parliament. The Regulations provide clinicians with assurance that, under certain circumstances, they must inform us when they suspect a transplant-related crime may have taken place. Simultaneously, it also introduces a responsibility on clinicians to notify us of patients who receive an organ transplant outside the UK.

The Regulations came into force on 1 April 2024 and we developed guidance to support clinicians in response. We also collaborated with NHSBT to promote the Regulations once they were laid to help ensure clinicians were prepared.

Work on this area continues. It involves collaborating with NHSBT, tailoring our police referral process and considering the impact of the Regulations. We continue to refer suspected cases of an organ transplant-related offences to the police for investigation, to protect vulnerable people.