In the past few years there have been about 340 organ donors per year, providing for about 1000 recipients. In Australia, approximately 1600 people are on a waiting list for organs at any one time. If those 1600 hope to get a new organ, we need higher rates of donation. The good news is that you can help.
Why the organ shortage?
Very few people qualify as potential organ donors. Donated organs must meet certain medical criteria, such as being free from disease (generally speaking), and there are age limits on organ donors. Organs have a limited life after the heart stops beating, as lack of oxygen and build-up of toxins quickly render them unsuitable.
The primary source of donors is people who die in hospital, typically in the intensive care unit (ICU) where support systems are in place. About half of Australian organ donors suffered from a stroke or brain haemorrhage, and about one quarter from traffic accidents. Of all the people who die each year, very few – only about one percent – are suitable organ donors.
Australian donation rates are low (about 15 per million people in 2011 and 2012) compared with many other developed countries, though rates have increased from around 11-12 per million five years previously. There are several reasons for this: relatively low numbers of potential donors (we have low rates of trauma from car accidents and firearms compared with some countries), potential donors not being identified, and a need for more hospital resources for end-of-life supportive care of potential donors.
The main reason is a low consent rate. Only about 56% of relatives who are asked about organ donation give their consent, which is at odds with the much higher percentage of people who claim to support organ donation (more than 90%). And the main reason for refusing consent is that surviving relatives don’t know the wishes of the patient.
How can we increase donation rates?
The country with the highest rates of organ donation is Spain, with about 33 donors per million people. They have a system of presumed consent, where it’s assumed organs will be donated unless the person has lodged an objection. They also use donor coordinators in every hospital with ICU facilities. The coordinators are specially trained professionals who actively seek potential donors, working closely with the medical teams and relatives of potential donors.
The donor coordinator approach is being adopted more widely throughout the world, and has been in place in South Australia since the mid-1990s. Donation rates in SA were subsequently higher than any other Australian state or territory at more than 20 per million people – roughly double the national average. The scheme has been rolled out nationally, and rates have increased in other states. In 2012 NT rated highest at 34.1 per million people, followed by Tasmania (29.3) and ACT (20.3). NSW was lowest at 12.1 per million.
The introduction of a presumed consent, or opt-out system, is more controversial. Proponents of the presumed consent system argue it doesn’t result in unwilling relatives being forced to agree to donation, because people who object to their own organs being donated can lodge their objections on a register, and families can object on their behalf. And in some presumed-consent countries, such as Spain, relatives are still consulted about organ donation – though they’re asked whether they object to the organ donation, rather than if they agree to it.
Opponents are concerned that presumed consent undermines the concept of organ donation being a gift, and that it also has the potential to erode trust in doctors who may be perceived to be acting in the interests of potential recipients rather than the patient.
If consent rates were increased to about 80% in line with Spain, it’s been estimated that Australian donation rates would increase to 17 donors per million. And if all suitable donors were identified, and consent was given in all cases, most of Australia’s need for organs would be met.