I refer to the article in Crikey on Friday about organ donation. I feel for Tim Richards and the other 1,900 people waiting for an organ transplant. And I agree it is a tragedy that a hundred people die each year waiting for a transplant.

But I disagree with his argument that many of those people wouldn’t still be waiting or dying if Australia adopted a system of presumed consent to organ donation – the so-called “opt-out” system.

Mr Richards and other proponents of opt-out argue that Spain has a better donation rate than Australia. Spain has an “opt-out” system. Therefore if Australia adopted an “opt-out” system we would have the same rate as Spain.

Spain adopted the opt-out system of consent in 1979. But its organ donation rate did not begin to improve until 1989 when it adopted a system of putting organ donor coordinators into hospitals. Since then the donation rate per million population has increased from 14 to 35. A recent Churchill Fellow who studied organ donation systems in the USA, the UK and Spain concluded that: “the increase in organ donation during the nineties cannot be attributed to any change of the Spanish legislation which has remained unmodified since 1979.”

It should also be noted that despite the legal presumption of consent for organ donation, the Spanish system does ultimately allow the families of the deceased to refuse donation.

The second most successful country in terms of organ donors per capita is the United States – which has the same system of consent as Australia.

The fact is that Australia has had outstanding success as a nation in reducing many of the factors that maintain the pool of potential organ donors. During the past two decades we have halved the road toll, we have made significant inroads into the death rate from strokes and, unlike the United States, we have very few gun-related deaths.

As the Spanish and United States experience shows, improving practices and procedures at the hospital level can generate substantial improvements in donation rates. The United States Organ Donor Breakthrough Collaborative, involving hospital-based teams pooling information, has increased the number of donors per month by 30% over four years. A similar initiative in Australia introduced in some hospitals in mid-2006 and now extended to 22 hospitals is showing great promise.

We should not let talk of “opt-out” options distract us from making the changes within the system identified by the National Clinical Taskforce. In developing its report it drew together a diverse and divided sector: it is now up to governments to take the recommendations and make them work.

And if we want to make a personal difference, we should register our consent to organ donation on the Australian Organ Donor Register at www.medicareaustralia.gov.au and discuss our decision with our family.

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Peter Fray
Peter Fray
Editor-in-chief of Crikey
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