Ground-breaking Development in Organ Transplants

A number of the newspapers this morning (Saturday 20th March 2010) are reporting on groundbreaking surgery carried out by British and Italian surgeons on a ten-year-old boy at St Ormonde's Street Hospital.

In the nine hour procedure a donor windpipe was transplanted into the boy (who has not been named). To decrease the chance of the new windpipe being rejected, however, the windpipe was stripped down to its collagen scaffolding and seeded with stem cells (taken from a sample of bone marrow extracted from the child's hip) which, it is hoped, will turn into specialised cells which form the inside and outside of the windpipe. Once transplanted into the child the expectation was then that his body would act as a 'bio-reactor' to help the windpipe grow into a fully functioning organ.

One of the major problems associated with organ transplants is, of course, the possibility of the donor organ being rejected by the recipient's body. To counter this problem the patient is put onto a life long regime of immuno-suppresant drugs designed to stop the recipient's body from attacking the 'foreign' organ. The downside of this is that the recipient's weakened immune system places them at a greater risk from infections and other life-threatening illnesses such as cancer.

Developments such as this are surely of massive significance for anyone who finds themselves on the transplant waiting list in the future. It is well known that the number of available donor organs currently falls far short of the numbers needed. Furthermore, it is also known that this problem is exacerbated by the fact that the likely success of any transplant also hinges upon how close a match the donor and recipient are in terms of blood type and tissue type. Consequently the prospect of being able to use the recipient's stem cells as a potential means of getting around such issues is surely an exciting one indeed.

No Prosecution Following the Death of Sir Edward Downes

In July 2009 it was reported that reknowned conductor Sir Edward Downes and his wife, Lady Joan Downes, had ended their lives with the assistance of Dignitas. The reports at the time noted that Detectives from Greenwich CID were investigating the circumstances surrounding the deaths of Sir Edward and Lady Joan Downes, specifically whether their children had assisted their parents to commit suicide.

The Director of Public Prosecutions announced today (Friday 19th March 2010) that after a careful review of all the evidence there was insufficient evidence to support a charge against the Downes' daughter, Ms Boudicca Downes. Furthermore, whilst there was sufficient evidence to support a charge against the Downes' son, Mr Caractacus Downes, of an offence under s.2(1) Suicide Act 1961, it was felt that it would not be in the public interest to prosecute him. Mr Caractacus Downes had booked a hotel room for his parents' use before they attended the Dignitas clinic. He also accompanied them from England to Switzerland.

The significance of this case is that is reportedly the first case where the public interest factors outlined in the Crown Prosecution Services 'Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide' (2010) have been applied. The DPP has kindly identified the factors that were taken into account when deciding whether it was in the public interest to prosecute in this case or not.

Factors tending in favour of prosecution in this case were identified as follows:

• It is clear that both Sir Edward and Lady Joan Downes were both able to undertake by themselves the actions which Mr Caractacus Downes undertook on their behalf.
• The evidence suggests that Mr Caractacus Downes was motivated entirely by compassion - even though there was also evidence which shows that he gained some financial benefit under the terms of his deceased parents' wills. On this point the Director of Public Prosecutions comments: "The relationship between compassion and financial gain is considered in paragraph 44 of the Policy. There, it is recognised that a suspect may gain some benefit from the resultant suicide of the victims. The Policy states that the critical element to consider is the motive behind the suspect's act. If it is shown that compassion was the only driving force behind his actions, the fact that the suspect may gain some benefit will not usually be treated as a factor tending in favour of prosecution."

Factors tending against prosecution identified in this case were as follows:

• It is clear that both Sir Edward and Lady Joan Downes had each reached a voluntary, clear, settled and informed decision to commit suicide.

Ultimately it was decided that the factors tending against prosecution outweighed the factors tending in favour of prosecution. This is consistent with the observation in the Crown Prosecution Service's 'Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide' that "Assessing the public interest is not simply a matter of adding up the number of factors on each side and seeing which side has the greater number ... It is quite possible that one factor alone may outweigh a number of other factors which tend in the opposite direction."

NB: It should be noted that since the Downes committed suicide prior to 1st February 2010, the Crown Prosecution Service would have been considering whether there was sufficient evidence to convict their children of the offence of aiding, abetting, counselling or procuring a suicide contrary to the 'old' s.2(1) Suicide Act 1961. That has since been replaced follwoing the enactment of s.59 Coroners and Justice Bill 2009. The 'new' s.2(1) offence (assisting or encouraging suicide) will, however, only apply to assisted suicides which occur after the 31st March 2010.