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Health Related Actions: Organ donation
Organ transplants and waiting lists
While tissue can be taken from the body after the heart stops beating, the requirements for organ donation are more restricting, and few people die in circumstances that allow them to become organ donors. Organ donation is usually only possible in cases where a patient in an intensive care unit is determined to have suffered brain death, while their heart/lung function is being maintained artificially. Some health conditions rule out donation, and age can also be a consideration, although in the case of kidneys and livers, there is effectively no age limit on donors. It is estimated that currently up to 1%of people who die in a year might have the potential for organ donation.3 Only a small proportion of these actually become donors; hence there is a shortfall in organs for transplantation.
WAITING LISTS AND TRANSPLANTS
Source: ANZOD Registry Report 2001. Waiting list data reproduced by ANZOD from individual waiting lists and the National Organ Matching System.
In 1999-2000, there were 35 organ transplant units in Australian hospitals, comprising 20 renal units, 8 liver units, 5 heart units and 2 pancreas units.4 During 2000, there were about 650 transplants from deceased donors. Nevertheless, close to 1,800 people were on a waiting list in January 2001, similar to the number early in 2000.
The contrast between waiting lists early in 2001 and the number of transplants performed over 2000 gives some indication of the extent of the need for organs for transplant, and whether it is being met. The largest waiting list, by a considerable margin, was for a kidney transplant. There were 1,487 people on this list in January 2001. In contrast, over the whole of 2000 there were 350 kidney transplants from deceased donors. This roughly indicates a waiting period of four years for a kidney transplant from a deceased donor. Likewise, the data suggest average waiting periods of one year for a heart transplant, and six months for a liver transplant.
WAITING LIST FOR KIDNEY DONATION, AND KIDNEY TRANSPLANTS
(a) Number of people on waiting list at one date each year.
(b) Number of people who received a kidney transplant over entire year from deceased donors.
Source: ANZOD Registry Reports 1997 and 2001. They reproduce waiting list data from ACCORD (pre 1998); Australians Donate (1998); and from individual waiting lists and the National Organ Matching System (1999, 2000).
However, waiting times can vary greatly for individuals, and some people die before organs become available. Information on the lengths of time people spend waiting for a transplant, and the outcomes for them, including death before an organ becomes available, would be necessary for a more detailed discussion of waiting periods.
In 2000, 196 deceased people became organ donors. They made up 0.15% of all people who had died during the year. Between 1989 and 2000 there have been 2,387 donors (an average of 199 per year).
Slightly more than half of the organ donors in 2000 (52%) had died from a cerebral vascular accident such as a stroke or brain haemorrhage. Road trauma was the next most common cause of death (21%), followed by other trauma (11%). Donors ranged in age from less than 1 year to 77 years, with an average age of 41 years. Males made up over half of all donors (57%).
From close to 200 donors, over 650 people benefited through receiving an organ transplant. The number of donors in each State or Territory ranged from 55 in the most populous State, New South Wales, to five or less in Tasmania and the two Territories, which have smaller populations.
ORGAN DONORS - 2000
(b) ACT hospitals tend to be used by people in the southern NSW region.
Source: ANZOD Annual Report, 2001; ABS Deaths, Australia, 2000 (ABS cat. no. 3302.0).
Donation rates in Australia
In 2000, the Australian organ donation rate was 10 per million population. There was considerable variation in the rates for the States and Territories. South Australia had the highest rate, 20 donors per million population. In other States for which reliable rates could be calculated, rates of donation ranged from 9 per million population for New South Wales, to 12 for Western Australia.
While calculating the number of donors per million population is a widely accepted way to compare donation rates over time and between areas, it is also useful to calculate rates per 1,000 deaths. This takes account of those differences in donation rates which are caused by differences in the crude death rate. In 2000, the ranking of the Australian States and Territories by the number of donors per 1,000 deaths was the same as their ranking by donors per million population. This suggests that differences in the crude death rate are not a major reason for differences in organ donation rates between the Australian States and Territories.
Hospital procedures regarding organ donation are one factor which can influence donation rates. In 2000, Spain had the highest donation rate in the world and this has been attributed to a range of hospital procedures in place there. There is some evidence to suggest that donation rates in Australia could also be increased with appropriate procedures. In South Australia, intensive care clinicians play an important role in maintaining intensive care patients and requesting donation, and emergency department procedures are also said to have contributed to the high donation rate.7
Research in other States and Territories to identify obstacles to donation has also pointed to the importance of hospital procedures.7, 8 Studies found that the most common reason why donation of organs from a medically suitable potential donor did not occur was that medical practitioners did not request donation after the patient was determined to be brain dead, instead withdrawing, or not starting heart/lung support. A less common reason was that relatives refused consent.
Willingness to donate
Public attitudes to donation also play a part in donation rates. In 2000, a national register was established of people who are prepared to be organ donors after death. Prior to electronic registers being set up, questions included on State drivers' licenses were the main way a person's intentions could be noted. In 2002, the proportions of current license holders who had answered 'yes' to organ donation was 45% in New South Wales and Tasmania, 47% in South Australia and 52% in Queensland. Information was incomplete for Western Australia and Victoria, and was not collected by the transport authorities in the two Territories.9
Survey data from November 1999, indicate that almost half (48%) of people aged 18 years and over had taken steps to be an organ or tissue donor after death.10 About a third (33%) of people had expressed an intention to donate on a driver’s license, 5% carried a signed donor card and 33% had discussed their willingness to donate with family members.
The proportion of people who had taken at least one of these steps to donate was highest in the 35-44 years age group, with those aged 25-34 years ranking second (54%). The lowest proportion was recorded among those aged 65 years and over (29%). Women were somewhat more likely than men to have taken steps (51% compared with 45%).
Regardless of the intentions a person declares, the consent of next-of-kin must be obtained. Market research on organ donation in the 1980s, found that although two-thirds of people said they were either definitely or probably prepared to be donors after death, fewer (38%) said they would definitely or probably donate the organs of next of kin.11 Organisations such as the Australian Kidney Foundation promote the discussion of organ donation within families, in the hope that if people express their intentions while alive, this will alleviate the stress on their relatives if faced with the decision of whether or not to consent to organ donation.
In 2000, 19% of donor families offered consent before it was requested. However, most commonly consent was requested, either by intensive care clinicians or registrars (57%), donor coordinators (22%), or nursing staff (2%). Regardless of who requested donation, most families had contact with a donor coordinator - either face to face (87% of all donor families) or by telephone (8%). This practice was observed in every State and Territory.1
PEOPLE WHO HAD TAKEN STEPS(a) TO BE AN ORGAN OR TISSUE DONOR - 1999
(a) At least one of the following steps was taken: person was a donor on drivers license, carried a signed donor card, or discussed willingness to donate with family.
Source: Population Survey Monitor, November 1999 (ABS cat. no. 4103.0).
1 Australia and New Zealand Organ Donation Registry (ANZOD) 2001, ANZOD Registry Report 2001, ANZOD, Adelaide.
2 Australian Red Cross Blood Service Coordination Centre for Organ and Tissue Donation NSW/ACT 2000, Fact Sheet, July 2000, Sydney.
3 Australians Donate 1999, Inaugural National Forum on Organ & Tissue Donation, 12-13 April 1999, Summary and Strategies paper, p. 3, Australians Donate, Adelaide.
4 Australian Institute of Health and Welfare (AIHW) 2001, Australian hospital statistics, 1999-–00, AIHW Cat. no. HSE 14, AIHW (Health Services Series no. 17), Canberra; Australian Bureau of Statistics 2001, Private Hospitals Australia, 1999-2000, cat. no. 4390.0, ABS, Canberra.
5 Australia and New Zealand Dialysis and Transplant Registry, 2002, ANZDATA Registry Report 2001 <URL:www.ANZDATA.org.au/annual reports/24th annual report> accessed 12 March 2002.
6 Australian Donate 2000 Second National Forum on Organ & Tissue Donation, 17-18 July 2000, Best Practises Summary/Outcome paper pp 9-12 Australians Donate, Adelaide.
7 Totaro, Paola 2001 'Doctors call for organ donation overhaul' The Age July 31 2001 <URL:http//www.theage.com.au/news/ 20000731> accessed 11 February 2002.
8 Hibberd, A. D., et al 1992, 'Potential for cadaveric organ retrieval in New South Wales', British Medical Journal, May 1992; 304:1339-43.
9 State Departments of Transport, drivers' license statistics.
10 Australian Bureau of Statistics 2000, Population Survey Monitor November 1999, cat. no. 4203.0, ABS, Canberra.
11 Dye, Peter 1995, 'Donation in Australia: An historical overview, current directions and future principles' Anaesthesia and Intensive Care, Vol 23, No. 1, February 1995.