On February 14 the Federal Government revealed its Organ Donor System Blue Print; 28 days later, an estimated 11 people have died waiting for a transplant Tim Richards, convenor of the Transplant Waiting List Advocacy Group, has been waiting for heart and double lung transplant for three years.

The Federal Government has now received its blueprint for action on the organ donor system. The blueprint, a report entitled National Clinical Taskforce on Organ and Tissue Donation Final Report: Think Nationally, Act Locally, was received by the Government 14 February 2008 from the now disbanded National Clinical Taskforce on Organ and Tissue Donation.

The Report contains 51 recommendations for improving the organ donation system in Australia.

The key observation buried in the Report is that over the past two decades the general measure for the availability of organs, known as the donor rate, has shown a decline from a 1988 level of 14 donors per million people to a 2006 level of 10 donors per million people, a very low donor rate.

The Taskforce suggests that its recommendations should work towards lifting the organ donor rate to 15 donors per million people, which seems an uninspiring target considering historical levels. (The donor rate should not be confused with the number of people who have registered their wish to donate their organs, as the donor rate refers only to the actual number of people who have died and given their organs to save others, on a yearly basis.)

The Report shows that Australia has major systemic problems with its organ donation system and that one country, Spain, is held up as the pinnacle of organ donor success. The Report summarises the Spanish system as follows:

The Spanish system, in particular, has been successful in securing higher rates of organ donation, though this has not translated into similar gains in eye and tissue donation. The system consists of a three-level transplant coordination network: national, regional and hospital. It is based on a presumed consent legislative framework (opting-out). However, family members are still consulted before organ donation can take place.

Yet despite going on to state that Spain has “excelled” at organ donation and that the “Spanish program provides a useful model for identifying best practices,” one of the program’s obvious key features, being the system presumes a person consents to donation unless they object (opt-out), is selectively isolated and downplayed with a significant attempt made to generally argue against its local relevance and importance.

The Taskforce appears to go as far as fear mongering, stating “surveys have indicated that there is a pre-existing element of medical mistrust within the Australian community… [and that it] considers that a presumed consent system may feed these fears and most likely lead to an increase in the proportion of registrations of objections to donation.”

Confusingly, the Taskforce states early on in its Report that it “did not consider that this area [an opt-out organ donation system] should be a focus of its work” but then goes on much later in the Report to state “the Taskforce recommends against the introduction of a presumed consent (opt-out) approach by any Australian state or territory.”

Peppered throughout are a handful of justifications against introducing opt-out. Either the Taskforce didn’t focus on the issue or it did, because it recommends against introducing opt-out. These conflicting positions raise questions as to what extent the Taskforce actually considered the opt-out issue. It should also be noted that this recommendation is not one of the 51 recommendations.

In any event, any benefits of an opt-out system are not canvassed in the Report except for those implied by the elephant in the room, Spain.

And far from the situation in Australia being so different as to make opt-out almost irrelevant, the report shows how legally fragmented the organ donation system is in Australia, with each State and Territory having its own take on the law, with the Federal Government trying to sit on top of this mess applying inappropriate one size fits all systems. For instance Medicare’s online organ donor registration system requires a person to complete a hardcopy form to properly register their consent as part of the “online” process. Which apart from being ridiculous for a supposed “online” process is actually something completely unnecessary for those in Victoria and New South Wales where the law does actually allow a person to consent online in a particular manner, an observation contained in the Taskforce Report. Introducing opt-out provides a real opportunity to align the many inconsistencies and so it is very important and relevant to Australia.

The Liberals’ Senator Boyce seems to be the only politician who has pulled the Government into some sort of debate on the issue of introducing an opt-out system, through the Senate Standing Committee on Community Affairs. But Hansard from the 22 February 2008 Committee records the superficiality of the debate with Senator McLucas implying that those advocating for an opt-out system were “grabbing” onto what they thought was a “simple solution” and stating that “in Australia an opt-out system would not change where we are”.

The Report’s rickety detail on the issue of type of organ donation system supports the status quo and the Government has embraced the Report. Unless the Government changes its stance, the 51 recommendations of the Report are the Government’s key foundation for moving forward. That doesn’t of course absolve the Government from its duty to protect its people however, and the transplant waiting list death toll continues unabated with an estimated 150 people dying each year merely waiting for a transplant, a figure just under 10% of last year’s national road toll. And since release of the Report to the Government 28 days ago (as at the time of writing) estimates suggest that about 11 people have died waiting for a transplant solely because there is insufficient availability of organs.

Meanwhile Senator McLucas advised the Senate Standing Committee in February that the Government is implementing the Report and has so far “established a beautifully termed cognate committee, which will be the next phase. Its task is to look at the 51 recommendations of the task force and to make further recommendations.”

Peter Fray

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