London

Donations of human tissue for research look set to slump in the United Kingdom following revelations about the systematic misuse of human remains at a Liverpool hospital.

A pathologist at Alder Hey Hospital was found to have stripped and stored every organ from every child whose parents allowed permission for a post-mortem. In the wake of a report on the episode by the Royal Liverpool Children's Inquiry, which was published last week, other pathologists are facing a crisis of public confidence that may lead to a shortage of donated tissue for research. The political fallout from the episode has also led to the immediate suspension of some research projects, with researchers unwilling to continue until ethical and legal guidelines are clarified.

The report focuses on the actions of former Alder Hey pathologist Dick van Velzen, Professor of Foetal Infant Pathology at the hospital between 1988 and 1995. It found that van Velzen systematically ordered the unethical and illegal stripping of every organ from every child who had a post mortem.

Carol Wainwright leaves Alder Hey with her son Joseph and the remains of his twin, Oliver. Credit: PHIL NOBLE

The pathologist failed to tell parents that their children's organs would be retained. He claimed he needed the organs for research into sudden infant death syndrome, but the inquiry found that most were never used in research, or even properly examined.

Other pathologists have sought to distance themselves from his actions, but the incident has focused attention on organ collections and libraries of tissue samples held at hospitals and research centres across the country.

James Underwood, professor of histopathology at Sheffield University and vice-president of the Royal College of Pathologists, says that fewer people have agreed to organ and tissue removal since the news about Alder Hey hit the headlines in 1999.

“The number of hospital post-mortems is down and it is becoming increasingly difficult to get certain tissue for research, particularly brain tissue,” he says. This is used to study conditions such as multiple sclerosis and variant Creutzfeldt–Jakob disease (vCJD).

James Lowe, a neuropathologist at the Queen's Medical Centre in Nottingham, says tissue shortages are already damaging his efforts to monitor vCJD cases in the region. “Pathologists are no longer confident about removing brain tissue samples during post-mortems,” he says. “So if an elderly person with dementia falls and dies, for example, nobody is checking what disease may have caused them to fall.” Lowe expects organ and tissue donation following post-mortems to drop still further. Similar declines followed recent protests about organ retention in France and Scandinavia, he notes.

In an effort to rebuild public confidence, the government is promising reforms and a stricter enforcement of existing laws. The laws allow tissues or organs to be retained after a post-mortem if relatives do not object.

Some UK pathologists say that threats of legal action are creating uncertainty even where the research uses tissue that would otherwise be destroyed, such as that removed during surgical procedures or for diagnosis.

“People have changed their attitude to tissue collection overnight,” says Phil Quirke, head of histopathology at the Leeds Teaching Hospitals NHS Trust. “We are very uncertain about what we can and cannot do, so we've stopped collecting some material.” His group's research into colon cancer will be “severely held up until the situation is clarified”.

But president of the Pathological Society, Nicholas Wright, of St Bartholomew's Hospital, London, says Quirke is over-reacting. “I don't think there is any problem at all with using tissue excised during operations,” Wright says.

Other researchers are concerned about possible restrictions on access to archived tissue, most of which was collected under older codes of ethical conduct.

→ http://www.rlcinquiry.org.uk

→ http://www.mrc.ac.uk/tissues.html