If like me, you have been following EastEnders over recent months you will be familiar with the storyline focussed around cirrhosis and liver transplantation. Luckily, in soap land there is often a happy ending to such stories. In this case Phil Mitchell was given a liver transplant, on Christmas Day of all days too. However, in real life this is not always the case with three people dying everyday whilst on the transplant list waiting for an organ.
The liver is a complex organ which serves to complete several functions. These include:
- The removal of toxins from the blood
- Controlling fat and sugar levels in the blood
- Regulating hormones
- Helping with digestion
However, it is not just a result of alcoholism that someone may need a liver transplant another example can be an autoimmune disorder or cancer. Public views on organ donation in the UK are mixed. The total population thought to be in favour of organ donation is 90% but in 2012 just 18.7 million people had signed the organ donor register. In June, the British Medical Association called for a public campaign to increase the public’s awareness of organ donation as well as a soft opt-out system for donation in the UK. An opt-out system was supported by most patients in a study by Coad, Carter and Ling (2013). This was compared to a study prior to 2000 where most of the population opposed this idea. A number of factors have been shown to affect the public’s attitudes towards organ donation. Topics include but are not limited to religion, death, family beliefs and medical mistrust.
Liver transplantation can be carried out in one of two ways; orthotopic or living donor. Orthotopic donation is the most common and preferred form. Here a donated liver is taken from a recently deceased person and transplanted into a patient in need. Whereas live donor transplants involve a donor, usually a family member of the patient, having the right or left lobe removed. The lobe is then transplanted into the patient who has had their liver removed. Following transplantation both the donor and recipient’s livers will begin to regenerate and are usually back to normal size within 3 months.
Liver transplant in alcoholic patients has been controversial in recent decades. Public opinion polls have shown that the public prefer the recipients of donated livers to be those who have naturally occurring illnesses rather than alcohol related liver disease. Scotland has been shown to have some of the highest rates of death from liver cirrhosis in Western Europe. Yet the need to raise awareness of the condition and to encourage more people to sign the organ donor register is increasing. Between April and December 2006, 13 patients died whilst waiting for a suitable liver in Scotland alone.
The liver transplant unit in Edinburgh became the first NHS transplant unit to offer adult-adult living donor liver transplantation in 2006. A pioneering procedure, live donation could allow healthy donors to provide a new lease of life to someone with end stage liver disease. Particularly as deceased donations at the time were limited. A study carried out by McGregor et al., (2007) looked at the public attitudes towards liver transplantation as well as the attitudes of GP’s. 1041 members of the public participated in the study which comprised of a short questionnaire alongside 155 GP’s working in Scotland.
Overall the study showed the majority of the general public in Scotland were in favour of live donor liver transplants. These statistics may not be a shock but the fact that only 34% wish to donate their organs when they die compared to 85% of GP’s might be.
One reason may be the public’s distrust in the medical system. Irving et al., carried out a study in 2012 to ascertain factors which influence attitudes to donation. One factor which was identified by the group was medical mistrust. Many of these assumptions were based on previous experience and exposure to the healthcare system. One of the major concerns from the participants in this study was the belief doctors wouldn’t try as hard to save their life if the medical professional was aware they wished to be an organ donor. Another reservation was the idea organs would be removed prematurely.
Barriers such as these are what’s needed to be overcome by organisations such as the NHS Blood and Transplant service to try to encourage people to become organ donors. Especially as the topic of organ donation is complex and can be affected by so many issues in our society. One way which may be acceptable in breaking down barriers and forcing individuals to talk about organ donation is to highlight it in one of the country’s most popular soap operas. For example, Morgan, Movius and Cody (2009) found that the public acquired knowledge through watching popular TV programmes even if at times the information wasn’t wholly accurate. Furthermore, the study also found those who may not have been willing to consider organ donation before were more willing to donate their organs if the programme clearly encouraged it. Therefore, we shouldn’t underestimate the power of entertainment media to influence knowledge, behaviour and attitudes towards topics such as organ donation.