Tony Zappia (Makin, Australian Labor Party, Shadow Parliamentary Secretary for Manufacturing) Share this | Hansard source

This bill, the Australian Organ and Tissue Donation and Transplantation Authority Amendment (New Governance Arrangements) Bill 2016, amends the Australian Organ and Tissue Donation and Transplantation Authority Act 2008 to do three things: firstly, establish the Australian Organ and Tissue Donation and Transplantation Board; secondly, abolish the existing Australian Organ and Tissue Donation and Transplantation Authority Advisory Council; and, thirdly, transfer responsibilities currently vested in the CEO to the board.

The CEO's role once the board is established will be to manage the day-to-day administration of the authority. The eight-member board will have a chair, deputy chair, CEO and five other members. It will be formally appointed by the Commonwealth minister on a part-time basis, and the chair will be nominated by the Commonwealth. With respect to the appointment of the chair, I thank the government for offering to consult the opposition over the appointment of the chairperson.

Before appointing the deputy chair and board members, the minister must request that the jurisdictions provide a written notice nominating one or more persons for the role of deputy chair and the COAG Health Council to provide a written notice nominating persons for appointment as board members. Board members are to be paid the remuneration that is determined by the Remuneration Tribunal or, if no determination is in operation, the member is to be paid the remuneration that is prescribed by the regulations. The existing advisory council members are remunerated according to the Remuneration Tribunal determination.

The bill also provides that the board may delegate some of its functions to the CEO. It further provides that the chair is to have substantial experience in or substantial knowledge of public administration, business or management. Board members, including the deputy chair, are required to have substantial experience, or substantial knowledge of, at least one of the following fields: public hospital administration; community leadership or representation in relation to organ or tissue donation and transplantation; consumer health issues; promotion of health issues; any other appropriate field of expertise; or the person has substantial clinical expertise in organ or tissue donation; or the person has substantial clinical expertise in organ or tissue transplantation; or the person is a consumer of health services.

By way of background, in 2008, then Prime Minister Kevin Rudd committed to making organ and tissue donation a national priority. The Australian Organ and Tissue Donation and Transplantation Authority—also referred to as the organ and tissue authority or simply the OTA—was established as part of the national reform program in 2009. The nine key elements of the national reform program were to establish a new national approach and system for organ and tissue donation; establish a national authority and network of organ and tissue donation agencies; establish specialist hospital staff and systems dedicated to organ donation; provide new funding for hospitals; provide national professional education and awareness; provide coordinated, ongoing community awareness and education; provide support for donor families; establish a safe, equitable and transparent donation and transplantation network; promote national eye and tissue donation and transplantation; and undertake additional national initiatives, including living donation programs.

The OTA is an independent statutory agency within the Australian government health portfolio. Currently there is no board of governance responsible for the overall strategic performance of the organisation; however, an advisory council was established to provide advice to the CEO. The OTA manages the implementation of the national reform program through leadership of, and collaboration with, state and territory medical directors, DonateLife agencies—of which each state has one—and hospital medical and nurse specialists in organ and tissue donation. These people and organisations comprise the DonateLife Network. State and territory governments, through funding agreements with the OTA, deliver organ and tissue donation services in the public hospital sector and, where mutually agreed, in the private hospital sector as part of the national reform program. States and territories use these funds to employ the DonateLife Network staff, in accordance with a nationally consistent organ and tissue donation service delivery model.

The proposal to abolish the advisory council and replace it with a board arose from the recommendations of the Ernst and Young review, which was commenced in June 2015 and reported in August 2015. The Ernst and Young review made 24 recommends, of which five deal with governance. All five recommendations are reflected in the bill. I want to go through those five recommendations individually, because they are all relevant to this legislation. Recommendation 5:

The Australian Government should consider amendments to the Australian Organ and Tissue Donation and Transplantation Authority Act 2008 to establish a Board of governance of seven to nine people to govern the OTA.

Recommendation 6:

The Chair of the Board of governance should be an experienced leader of public hospital organisations, but need not be a clinician.

Recommendation 7:

The skill base of the Board should include community leadership, health promotion expertise, DonateLife Network clinical expertise, transplantation clinical expertise, consumer experience, and communication skills.

Recommendation 8:

The Chair should be nominated by the Australian Government, the deputy Chair nominated by the states and territories, with the balance of members nominated collectively by the Council of Australian Health Governments Health Council (CHC) members.

And recommendation 9:

The members should be appointed for a term of four years by the Australian Government Minister, with staggered appointments at the commencement of Board of governance operations.

There has been considerable debate over the years about the need to raise organ donation rates throughout Australia. Much of the increase from 11.4 deceased donors per million population in 2009 to 18.3 in 2015 is a consequence of Labor's reforms. However, Australia is still well short of the target of 25 donations per million people.

The following statistics highlight the difficulty in finding donors. In 2015, there were almost 154,000 deaths in Australia, of which around half, or 74,000, were in a hospital. Of those, 970, or a little over one per cent, were in the specific circumstances where the potential for organ donation was identified. Nine hundred and forty requests to families for donation were made and 564 families consented. There were 129 cases where family consent was given, but donation did not proceed for clinical reasons. This resulted in 435 deceased organ donors for the year.

What can be done to improve that figure? We know that, in 2015, 91 per cent of families agreed to donation where the deceased had registered their decision to donate. That figure drops to 52 per cent if the deceased was not registered and the family had no prior knowledge of their wishes. This highlights the importance of registering on the Australian Organ Donor Register. Currently, there are around 6.2 million people on the register, which includes about 26,000 who do not wish to donate. Around 150,000 signed up in the year 2015-16. Clearly, ensuring that families know the deceased's wishes through greater participation on the Organ Donor Register will maximise the number of requests that are agreed to. I note that South Australia is currently the only jurisdiction where a person can register their organ donation decision via their driver's licence. Interestingly, 64.7 per cent of South Australians over the age of 16 are on the Organ Donor Register. That is a much higher figure than for the rest of Australia, and it is perhaps something that we should consider looking at to see if the other states might benefit by applying the same system.

I want to turn for a moment to living donors. Whilst most of the focus has been on deceased donors, we should not ignore the incredible gift that living donors give, often to a close family member. In 2015, according to the OTA's annual report, there were 245 recipients of living donor organs. I note, however, that that figure has been trending downwards over the last three consecutive years. Living organ donation requires major surgery and, if the living donor is working, they will almost certainly need a significant amount of time off work for recovery. Some donors may have to take leave without pay, or may exhaust their paid leave entitlements during the recovery period. Labor introduced supporting leave for living organ donors as a two-year pilot from July 2013 to June 2015. The aim of the program was to help alleviate the financial stress that living organ donors may experience, by reimbursing employers for payments or leave credits provided to their employees for leave taken to donate an organ and recover from the procedure. The government followed that lead and has continued the program for another two years until June 2017.

Organ donation and transplantation saves lives and changes lives. The waiting lists for organs, however, are lengthy, often causing further health complications, additional health costs and productivity losses. I do not know if any cost-benefit studies on organ transplant have been carried out, but the figures would be interesting. There is financial and social urgency in lifting organ and tissue donation rates. One of my concerns about doing that is the shared responsibility between the federal government and the states and territories for organ and tissue donation and transplantation. Commitment to the program by each of the jurisdictions appears to vary and to be linked to the budgetary health priorities of each jurisdiction.

Establishing a board of governance to whom the CEO will report and be accountable is expected to make the authority more effective. However, an increase in organ donation and transplantation comes at a cost. Each transplant incurs a cost, both in the donation and the transplantation process, so raising transplantation rates will inevitably require additional funding. How that funding is to be provided, and by whom, is a matter that cannot be ignored if governments are serious about raising organ and tissue transplants.

Whilst considerable progress has been made, organ transplantations are still complicated matters. The medical professionals who carry out the procedures deserve our gratitude. It is through their work and research that lives are changed. In an article which appeared in the Adelaide Advertiser last Saturday, 19 November, Professor Toby Coates, director of kidney and pancreatic transplantation at the Royal Adelaide Hospital, commented on some research that was being carried out relating to kidney transplants at the hospital. Professor Coates said of the cold perfusion that is currently used:

… when we preserve an organ, it is put onto ice and kept at 4C until the person arrives for the transplant.

He went on to say:

What we want to do is warm profusion, so instead of chilling the kidney down, we would put it on a pump system to keep it at 37C and ticking over with oxygenated blood.

I commend Professor Coates and his team for the research they are carrying out. I have no doubt many other dedicated medical professionals are also continuously looking at improving the existing procedures.

In closing, I take this opportunity to thank and acknowledge the work of the organ transplant authority advisory council that has existed to date and all of the members that formed part of that council for the good work that they have done. It was, indeed, under their stewardship that the organ donation rates went from about 11 to 18 per million people in this country, which is a considerable increase. I also especially thank David Koch for his contribution as the chair of the OTA for a long period until he stepped down about a year ago. I have no doubt that his contribution was also a significant reason why the rates of donation went up. Labor supports this legislation for the reasons I have outlined. I again thank the minister, who is here at the table, for offering to consult with Labor with respect to the appointment of the chairperson for the board.

See this speech in context