Wednesday, 7 February 2007
I rise to speak on the very sensitive and important issue of organ donation in Australia. Australian Organ Donor Awareness Week 2007, from Sunday, 18 February to Saturday, 24 February, provides the opportunity to articulate what really is involved in organ donation—not only the shortfall in donors but the circumstances required to access a donor’s tissues or organs. This subject is not new to me. As a funeral director I encountered the subject on several occasions when dealing with and assisting bereaved families. I also have friends who have donated the organs of family members, resulting in the saving of five lives in Australia.
There is a perception that all registered donors will eventually save a life or lives. This is not necessarily the case. Only a limited number of donors will actually achieve this noble goal. My aim is to encourage more people to consider becoming donors and to explain why we have so few. Many Australians carry a card indicating membership of the Australian Organ Donor Register, but in many cases we, or our relatives, do not understand what circumstances are required to allow the harvesting of organs or tissue. A decision to become an organ donor should be shared with family, because permission is requested from the next of kin before donation can be effected. Carrying a card, having it in your will or expressing it in writing by other means is not the only solution; there needs to be family consent at the time the organ donation is to be effected.
It is surprising to many Australians that only one per cent of all hospital deaths occur in such a way that organ donation is medically possible. While some tissue can be taken from the body after the heart stops beating, the requirements for organ donation are more restrictive, with very few people dying in circumstances that allow them to become organ donors. Organ donation is usually only possible in cases where a patient is in an intensive care unit and is determined to have suffered brain death while their heart-lung function is still being maintained artificially. Some health conditions rule out donation. Age can also be a factor, although in the case of kidney and liver donation there is effectively no age limit. It should also be understood that there are critical time frames for various organ transplants.
In 2005 there were 35 organ transplant units in Australian hospitals, comprising 20 renal units, eight liver units, five heart units and two pancreas units. During 2006 there were 738 transplants from 202 deceased donors. The average number of organs transplanted per donor was 3.7. Nevertheless, close to 1,800 people were on a waiting list when this data was compiled in January 2007. The figure still hovers around 2,000. The contrast between the waiting lists and the number of transplants performed indicates the extent of the need for organs for transplant and whether those needs are being met.
Interestingly, you are 10 times more likely to be in need of a transplant than to ever be in a position to be an organ donor. Even if you were a donor, there are a strict set of circumstances which allow a transplant. Data indicates that the largest waiting list by a considerable margin is for kidney transplants and that there is a waiting period of about four years for a transplant from a deceased donor. The average waiting period for a heart transplant is one year and for liver transplants six months. However, waiting times vary greatly for individuals, and patients die before organs become available.
Kidney donation is the only widely practised form of organ transplant from live donors in Australia. Liver transplants from live donors have become an established treatment in some countries, and transplants of parts of the lung, pancreas and intestine are also performed.
Corneal tissue transplants were the first transplant operations to be commonly performed in Australia, and date from the 1940s. Organ transplants did not begin until 1963, when medical advances indicated kidney transplantation was an effective treatment. Transplants of the heart, liver, lungs and pancreas have been developed into effective treatments. Tissue transplants now include bone marrow, heart valves, bone and skin.
Figures released by the Australian and New Zealand Organ Donation Registry show that in 2006 South Australia continued to lead in the number of people who die and become donors, with 23 donors per million of the population—the highest rate of organ donation in the country. This was followed by Tasmania, with 16. With a population of nearly half a million, that equated to eight actual donors. The national average is 10 donors per million. However, it appears that the figure for Tasmania could be an anomaly, given that it has had a very low rate in past years.
Compared with other countries for which information is available, Australia’s donation rate is low. When organ donation rates are compared per 1,000 deaths, the difference between the donation rate for Australia and some other countries is reduced. It is suggested that Australia’s donation rate is comparable with estimated rates for New Zealand and several European countries, including the UK, Ireland, the Netherlands and Germany. Spain has for some years had the highest donation rate. This has been attributed to procedures introduced by a national transplant organisation set up in 1989. These included locating donation coordinators in hospitals, training medical staff in requesting donation and closely monitoring potential and actual donation. There is some evidence to suggest that donation rates in Australia could be increased with appropriate procedures, such as those established in Spain.
Public attitude to donation also needs to be considered. Donors and potential donors need to consider the psychological and emotional challenges that may accompany any decision regarding donation or transplantation. Many philosophical arguments against organ donation stem from the field of bioethics, which has emerged at the forefront of modern clinical science. This encompasses issues such as the moral status of organ donation. Further, it is almost impossible for involuntary organ donation to occur given the issues surrounding patient autonomy, living wills and guardianship. The issue of black market organ donation, generally in impoverished countries, opens up all sorts of moral issues regarding physical exploitation and financial exploitation, not to mention criminal considerations.
The national register of people prepared to be organ donors after death was established in Australia in 2000. More than 850,000 Australians have registered their legally valid consent or objection to organ/tissue donation, but many more are needed. The average waiting period for organs varies from 1.2 years to 3.8 years. Australia has an organ retrieval rate and a transplant survival/success rate higher than any European country and the US. One donor can help up to 10 people in need.
The purpose of organ donation is primarily transplantation. Where, in the uncommon situation an appropriately matched recipient is unable to be found after organ harvestation, separate and specific permission is obtained for donated organs to be used for transplant related research.
Death, or brain death, with organs still oxygenated is a rare occurrence. Often death is sudden or unexpected, so more people need to recognise early that they wish to be an organ donor. Families need to discuss this matter in advance so that when an unexpected decision at a very awkward time in their lives needs to be made—usually during a traumatic and difficult period—they are better equipped to make that decision. It is far better to know that the loved one who is dying—or has died—wishes to have their organs donated. To achieve a higher rate of organ donation, we need to know that every single person who dies in the circumstances that would allow organ harvestation has consented, is aware and knows the implications of what they are consenting to.
With this in mind, I fully support the Australian Organ Donor Awareness Week’s aims, which are: raise donation rates in Australia by focusing on the pressing need for organ and tissue donation; encourage families to discuss their wishes, highlighting the success of organ transplantation in Australia; and, finally, promote the registration of consent on the Australian Organ Donor Register. I hope this clears up many issues surrounding such a sensitive issue as organ donation. If the only aim that is achieved tonight is that people discuss their decision in their homes and workplaces, I feel I have made some contribution.