Academics and top medics back plans to expand organ donation

Academics and senior medical staff have backed plans to allow organ donation after circulatory death.

The legal reform could increase the number of available organs by as much as 50 per cent, they say. 

In a multidisciplinary position paper released this month, experts from the University of Malta and Mater Dei Hospital expressed support for government proposals to amend the Human Organs, Tissues and Cell Donation Act.

Currently, organ retrieval is only permitted following "brain death", when all brain functions have irreversibly ceased. The proposed changes would shift to a so-called DCD Model that allows organs to be harvested after "circulatory death," which occurs when the heart and lungs stop functioning permanently.

The report’s authors include specialists in ethics, theology, intensive care, and neurosciences. They argue the legislative change is essential to address a growing transplant crisis. By the end of 2025, more than 90 people in Malta were waiting for kidney transplants alone.

Health Minister Jo Etienne Abela first unveiled the DCD proposal in December 2024. The regulatory framework surrounding it was concluded a year later and the government has said the Opposition and Church have both backed the plan. 

Strict Ethical Safeguards

While the experts support the move, they stressed that public trust depends on "robust ethical and procedural safeguards."

A core recommendation is the "absolute separation" of medical roles. The clinicians responsible for a patient’s end-of-life care and determining his or her death must have no involvement with the organ transplant or retrieval teams. This is intended to ensure that the decision to withdraw life-sustaining treatment is based solely on the patient’s best interests, not the need for organs.

The paper also highlights the "dead donor rule," insisting that death must be determined with "moral and clinical certainty." This involves a mandatory "no-touch" observation period after the heart stops before any retrieval procedures can begin.

The authors noted that organ donation must remain a "voluntary gift." Under current laws, which the experts believe should be maintained, surgeons can only proceed if the deceased was a registered donor or if the next of kin provides consent.

Doctors treating patients must be focused on caring for them, and any discussion about organ donation should only occur after the donor, their family and physicians have agreed to discontinue life-sustaining treatment.

“The determination that further treatment is futile and should be withdrawn must precede, and remain separate from, any discussion of organ donation. This sequencing is essential to avoiding real or perceived conflicts of interest and to preserving the integrity of clinical decision-making,” the paper states.

The group said patients’ relatives must be given access to psychosocial support, the process should be subject to clear and transparent audits and reporting structures and medical staff receive training in ethics.

It also called for a public education campaign to ensure the transition to the DCD model is transparent and trust is sustained in the organ donation system.