Author's reply


I would like to thank Mr McKelvey for his considered response. He is correct that, despite the given title, I limited my discussion to anencephaly. This was because, as far as I understand, anencephaly represents the only situation worldwide, or in the UK, in which an infant delivered with an antenatal diagnosis of a ‘lethal fetal anomaly’ has donated organs and tissues to others.

Such pregnancies represent the totality of cases NHS Blood and Transplant (NHSBT) currently receives antenatal enquiries regarding potential donation, either from obstetricians or directly from affected pregnant women. While in no way seeking to prevent compassionate discussion about possible donation in situations of other lethal fetal conditions, I sought to provide helpful guidance for those facing a situation in which a pregnant women requests information, about the current situation. It is also important to acknowledge that due to history, and current ongoing requests, an anencephalic pregnancy represents the most likely situation in which donation might be facilitated for a family in the near future – if those ethical and practical issues I highlighted can be favourably addressed.

Mr McKelvey also reiterates that this situation affords a unique opportunity to discuss potential donation over a comparatively lengthy period. This is, indeed, in stark contrast to the majority of paediatric organ donations, in which parents have very limited time to consider such options – often at a time of acute tragedy.

I would encourage any obstetrician or other healthcare professional caring for a woman in such challenging circumstances – irrespective of the specific fetal anomaly – to approach NHSBT via their hospital's Senior Nurse in Organ Donation or possibly the Clinical Lead for Organ Donation, who will enable a thoughtful, compassionate, well-informed and, crucially, up-to-date response to questions of organ or tissue donation.