Medico-legal aspects of renal transplantation

Advances in clinical tissue and organ transplantation have enforced changes in legislation concerning the disposal of bodies and their parts. With the evolution of cardiopulmonary support systems came the concept of brain death. To enable physicians to withdraw support without transgressing the law, recognition in law of brain death was necessary. To ensure that the diagnosis of brain death was certain, eminent doctors in advanced communities have drawn up criteria of brain death which are widely recognised and applied with confidence by the medical profession. Organs for transplantation are best obtained from "heart beating cadavers". Despite public support for organ transplantation the requirements for organs to treat those presenting are not currently being met even though the number of patients who die and who could be suitable donors far exceeds that required. Increased public education to stimulate voluntary donation is necessary. Standardisation of care of comatose patients in hospitals is also required so that brain death may be diagnosed when it occurs. If the procedures for organ donation are familiar and well understood, suitable patients can then become donors according to their own or their relatives' wishes.