We are not doing well with organ transplants

By January 10, 2013Health, History, Research, Society

A few years ago I became involved with a group called Outcomes Australia whose purpose is clear enough from its title. There is a tendency in Australia, and indeed in every country, I should think, for soothing words to persuade us that things are better than they are really are. The issue that got me in was the discovery that our organ transplant rate was terrible. We worked away at it, got support from high and low, persuaded the then Minister for Health that she should make this a priority, provided a road-map of how that might be achieved, congratulated ourselves for having done a good job, and moved on to other things.

What was the problem? It was the mismatch between the numbers agreeing to be organ donors in the event of their imminent death (many millions, now), and the actual numbers of transplants occurring each year. What caused the problem? Well, that seemed to be a lack of system within hospitals: organ transplants were not high on the agenda, family members could intervene against the expressed wishes of the donor — saving someone else’s life was low down in the minds of those gathered around the dying person, and reasonably enough. We thought we had the right system, and the federal government seemed to agree.

What brought the question back to me was a small notice in a newspaper to the effect that a part of the NSW Government would no longer collect organ transplant wishes, and an earlier triumphal announcement from a Minister somewhere that Australia  had increased the proportion of those prepared to donate their organs. Yes, I thought, but what has happened in the hospitals?

Nothing of any consequence, is the answer. I think it was five years ago when the new Federal Government agreed to implement our plan. The outcomes are no better when they were then. ShareLife, the name of the project we worked on, put out its last scorecard in September last year. In July 2008, when the Government announced the new initiative with respect to organ transplants, the score was a bit over 30 actual transplants performed per million people.

The number went up almost at once to nearly 40 per million, dropped again fairly quickly when the excitement faded, and has then hovered around 40 or so ever since. OK, that’s at least an increase of about a third. But the real standard we should be aiming for, and were aiming for five years go, is to equal the level of transplants performed in the countries that lead in this field.

And we are at around half that figure. Spain is the world leader, and has been for some time. In 2011/2012 Australia saw 996 actual transplants carried out, or 43-74 per million. At the Spanish rate, of 90 per million, we would have seen 2,049 transplants carried out. What that means is that another 1,053 Australians would have lived, simply through working organs being moved from a dead person to a living one.

So why didn’t that improvement take place? The simple answer is that hospitals have not adopted the solutions that were set out in the government’s strategy. Why not? Because they are busy places, governed in different ways, not controlled by the Federal Government, and beset by many other problems.

Those of us involved at the time felt that a good and workable strategy supported by the Federal Government with some real money ($151 million in July 2008) must have a great chance of success. Plainly, we were wrong. What can we do about it? For the moment, I don’t have an answer.

But, inasmuch as we are able to persuade our own families to respect our own wishes in this matter, it seems to me that one thing we can do is to insist to our nearest and dearest that we mean what we say, and they are not to oppose those wishes — indeed, they are to support them — at the time of own imminent deaths, There is only a small moment where life can be transferred from one person to another. Let us make that moment as efficient as possible.

All of us, after all, would want there to be an organ for ourselves if we were in dire need.

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