Organ donation in Australia

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Organ donation is when a person gives their organs after they die to someone in need of new organs. Transplantation is the process of transplanting the organs donated into another person. This process extends the life expectancy of a person suffering from organ failure. The number of patients requiring organ transplants outweighs the number of donor organs available. [1]

Contents

History of organ transplantation

Australia's first organ transplants were corneal transplants in the early 1940s. Following in chronological order are monumental first in Australia's organ transplantation history. [2]

  1. Early 1940s Australia began corneal transplants in Sydney and Melbourne
  2. 1965 Australia's first successful (living) kidney transplant
  3. 1984 Australia's first successful heart transplant
  4. 1985 Australia's first successful liver transplant
  5. 1985 Australia's first successful kidney transplant from a deceased donor
  6. 1986 The Brisbane Technique for splitting livers to benefit three recipients initiated
  7. 1986 Australia's first successful heart/lung transplant
  8. 1987 Australia's first successful kidney/pancreas transplant
  9. 1987 First segmental liver transplant (for children) (Australia)
  10. 1989 First successful living liver transplant (Australia)
  11. 1990 Australia's first successful single lung transplant
  12. 2002 First single segment liver transplant on a baby (24 days old) (Australia)
  13. 2003 Australia's first triple transplant (heart, lung, liver)
  14. 2006 World's first kidney/liver/pancreas transplant (Australia) [2]
  15. 2012 Australia's first pediatric intestinal transplant (liver), (small bowel), (duodenum), (pancreas)

The following table (Table 1.1) shows the global transplantation milestones in chronological order.

Table 1.1. Global transplant milestones

YearMilestoneLocation
1823First skin auto graft transplantation of skin tissue from one location on an individual to another location Germany
1905First human to human corneal transplant. This was also the first successful human to human transplant of any kind Moravia (now Czech Republic)
1908First skin allograft-transplantation of skin from a donor to a recipient Switzerland
Early 1940sAustralia begins corneal transplants Sydney and Melbourne
1954First living related kidney transplant (identical twins) US
1955First heart valve allograft into descending aorta Canada
1962First kidney transplant from a deceased donor US
1965Australia's first successful (living) kidney transplant Queen Elizabeth hospital. South Australia
1967First successful liver transplant US
1967First heart transplant South Africa
1968First pancreas transplant US
1979Living related pancreas (mother to child) US
1981First heart/lung transplant US
1983First successful lung transplant Canada
1983 Ciclosporin approved for commercial use in the US. A revolutionary anti-rejection drug, it heralded a new era for kidney, liver and heart transplantation US
1984First heart-liver transplant US
1984Australia's first successful heart transplant St. Vincents hospital, NSW Australia
1985Australia's first successful liver transplant Princess Alexandra hospital, Brisbane Australia
1985Australia's first successful kidney transplant from a deceased donor Queen Elizabeth hospital, Adelaide Australia
1986First successful double lung transplant Canada
1986The 'Brisbane Technique' for splitting livers to benefit three recipients initiated Princess Alexandra hospital, Brisbane Australia
1986Australia's first successful heart/lung transplant St Vincent's hospital, NSW Australia
1987Australia's first successful kidney/pancreas transplant Westmead hospital, NSW Australia
1987First segmental liver transplant (for children) Princess Alexandra hospital QLD Australia
1988First successful intestinal transplant UK
1988First successful liver-bowel transplant UK
1988First two in one liver transplant (one liver split for two recipients) France
1989First successful living liver transplant Princess Alexandra hospital QLD Australia
1989First combination heart, liver and kidney transplant US
1990First living related lung transplant US
1990Australia's first successful single lung transplant St. Vincent's hospital NSW Australia
1992 Xenotransplant (pig liver to human) US
1992 Xenotransplant (baboon's liver to human) US
1995World's first laparoscopic live donor nephrectomy in which a patient's kidney is removed through a 5–6 cm incision US
1995Transplantation of all abdominal organs US
1998First successful human hand transplant (later removed) France
2002First single segment liver transplant on a baby (24 days) Princess Alexandra hospital, QLD Australia
2003Australia's first triple transplant (heart, lung, liver) Princess Alexandra hospital, QLD Australia
2005First successful partial face transplant France
2005First living donor islet transplant Japan
2006World's first kidney/liver/pancreas transplant Royal Prince Alfred hospital NSW Australia
2009Paediatric transplant for small bowel, liver, pancreas and two kidneys US

Table 1.1 Source: Australian Government Tissue Donation and Transplantation Authority. http://www.donatelife.gov.au

Donor types

There are two types of donors; living donors and deceased donors.

Living donors

In Australia the most common living donations not including blood donations are kidneys and bone marrow. The tissues and organs that are able to be donated by a living donor are: [3]

Eligibility for donation

The minimum age for living donation is 18 years of age. A person may be eligible to be a donor if they are free from HIV, cancer, systemic infection, sickle cell anaemia, Creutzfeldt–Jakob disease and they are not a previous IV drug user. [4]

Motives for living donation

Donation to a family member is a common scenario. The reasons for a family member to want to be a living donor to their relatives are; a desire to help, self benefit (from loved ones improved health), a feeling of moral duty, pressure identification with the recipient, increased self-esteem from doing a good deed. It is the health professional's role to understand the difficulty of these situations involving relationships of loved friends or relatives and they are to determine whether or not the offer of donation is genuine or the living donor feels pressured into donating because of the seriousness of their loved ones organ failure. However most donations result in a positive psychological benefit to both the donor and recipient. [3]

If a donor is wanting to donate to someone who is not a relative or friend they are intensively psychologically tested to determine their motives and suitability for donation as there can occasionally be harmful motives such as attention seeking or mental illness. [3]

Deceased donors (non-heart beating donors)

Deceased donors have been declared dead and are maintained in ICU on ventilators so tissue oxygenation continues until the procedure of organ retrieval and cold preservation. [5]

Deceased donors are divided into two sub-classes. [5]

Both types of deceased donors have complete and irreversible damage and returning to life is impossible. Thorough testing is carried out prior to confirming a person brain dead or cardiac dead. [4]

One deceased donor is able to save up to ten lives by donating the following:

Whole body donation

After death some people choose to donate their bodies to science. These bodies are used in many teaching facilities and aid in teaching anatomy, surgical techniques or research. Whole body donation involves the deceased person contacting the university or teaching institution prior to death to obtain consent and cover the legalities involved. After death it is up to the family of the deceased to contact the chosen facility and arrange donation. [1]

Opt in versus opt out

Currently Australia's organ donation system is 'opt-in'. This means a person had to give consent (opt-in) to be a donor prior to their death, or their family can make the decision for them if they are considered a viable donor. [7] The 'opt-out' system is used in several countries around the world. For this system everyone is placed on the donor list and must 'opt-out' if they do not wish to donate their organs. Whether Australia changes to the 'opt-out' system is constantly coming into question. In a discussion paper compiled in 2011 it was stated 35% of family members of a potential donor would refuse donation if they were unsure of the family members intentions on donating. However, if an 'opt-out' system was put into place and the potential donor did not opt-out prior to death, it was estimated only 20% of families would refuse donation. [8]

A study carried out in 2002 investigated donor rates of countries with 'opt-in' and 'opt-out' systems. The countries chosen for the study were ones that had relatively similar backgrounds and health systems. After the donation rates were calculated to match the mortality rates it concluded the difference in donor rates between the two systems were marginal. The results as follows (Table 1.2). [9]

Table 1.2. Three year mean organ donation and mortality rates for 10 European countries.

Reference: [9]

CountryThree year mean organ donation rates* (per million inhabitants)Three year mean mortality rates† for organ donation (per million inhabitants)
Spain 33.8309
Austria 23.5298
Belgium 23.0343
France 18.3330
Italy 16.8246
UK 13.2243
Netherlands (I)13.0187
Germany (I) 12.6240
Switzerland 12.5195
Sweden 11.3240
  1. *The rates shown comply with the definition of the council of Europe: "if at least one solid organ has been retrieved for the purpose of organ donation"
  2. †Mortality rates for CVA and (traffic) accidents 0–65 years
  3. (I) indicates country has an 'opt-in' system

There are many pros and cons for each of the two systems, making it a controversial topic, and as seen above some studies can be contradicting. Ultimately it is the family of the deceased who will make the final decision on organ donation. [10] Only 57% of Australians know the wishes of their family members in regards to organ donation, which has a large impact on families giving consent for organ donation. Donation cannot go ahead without families consent even if the person is on the donor register. [11]

Donation in religion

In most cases religions support organ donation. However, there are a few aspects of each religion that can make the logistics of organ donation difficult.

Islam

Most organ donations in predominately Muslim countries are live donations, for example in Iran in 2006 only 13% of renal transplants were from deceased donation. In Islam, violating the human body whether living or dead is forbidden, this includes organ donation. However, saving a life is ranked extremely highly in the Qur'an. Brain stem death (brain dead) is controversial in Islam. This, along with burial customs of Muslims being they have to be buried within 24 hours of death makes if difficult for organ donation. [12]

Christianity

Generally Christianity approves of organ donation although some Christians believe principle healing is achieved through prayer. The majority of Christians see organ donation as Christian love or an act of devotion to God and mankind. [12]

Judaism

The Jewish faith places great significance on avoiding unnecessary interference with cadavers and receiving benefit from a cadaver is prohibited. The body must also be buried within 24 hours of death. It is custom in Judaism to not interfere with death; organ donation procedures may be part of this. Only 8% of the Israel population are registered organ donors. [12]

Hinduism

Hindu's believe in reincarnation and the good deeds of one's current lifetime will determine the fate of the next lifetime. Organ donation is seen as a good deed. Hasmukh Velji Shah of the World Council of Hindus stated "The import issue for Hindu is that which sustains life should be accepted and promoted as Dharma (righteous living). Organ donation is an integral part of our living." [12]

Buddhism

Buddhists believe in rebirth. Brain death is also controversial for Buddhists as they believe the spirit remains in the body days after death and interfering with the body may affect a person's next rebirth. However, selfless giving is integral to Buddhism; therefore organ donation is up to the individual. [12]

Donor rates in Australia

Australian donor rates are on the rise. Between 2009 and 2013, donor numbers increased by 29%. In 2009 there were 11.4 donors per million population. By 2013 there were 16.9 donors per million population. (Table 1.3). In Australia around 1600 people are on the organ transplant waiting list at any time. Less than 1% of persons whose death is in hospital can be potential donors because of the limited circumstances for which organ donation is possible. [13] In 2013 only 40% of patients on the organ waiting list received a transplant and 2% of the patients on the waiting list died while waiting for an organ. [14]

Table 1.3: Donor rates in Australia per million population

Reference: [15]

YearOrgan donors

per million population

Organ transplant recipients

per million population

Organs transplanted

per million population

200911.437.239.5
20101442.845.1
201115.145.247.3
201215.646.348.8
201316.948.550.9


Table 1.4. Transplanted organs 2014 in Australia

Reference: [15]

OrganNumber
Kidneys 659
Livers 237
Hearts 79
Heart/Lungs 4
Lungs 159
Pancreas (including pancreas islets)54
Total1,193


Australian Organ Donor Register

The Australian Organ Donor Register is a government register. People can register to be organ donors or they can register that they wish to not be an organ donor. The register is nationwide and is the only register in Australia. Registering can be done online at the Donate Life website.

Related Research Articles

<span class="mw-page-title-main">Organ donation</span> Process of voluntarily giving away organs

Organ donation is the process when a person authorizes an organ of their own to be removed and transplanted to another person, legally, either by consent while the donor is alive, through a legal authorization for deceased donation made prior to death, or for deceased donations through the authorization by the legal next of kin.

<span class="mw-page-title-main">Organ transplantation</span> Medical procedure in which an organ is removed from one body and placed in the body of a recipient

Organ transplantation is a medical procedure in which an organ is removed from one body and placed in the body of a recipient, to replace a damaged or missing organ. The donor and recipient may be at the same location, or organs may be transported from a donor site to another location. Organs and/or tissues that are transplanted within the same person's body are called autografts. Transplants that are recently performed between two subjects of the same species are called allografts. Allografts can either be from a living or cadaveric source.

<span class="mw-page-title-main">Pancreas transplantation</span>

A pancreas transplant is an organ transplant that involves implanting a healthy pancreas into a person who usually has diabetes.

Prior to the introduction of brain death into law in the mid to late 1970s, all organ transplants from cadaveric donors came from non-heart-beating donors (NHBDs).

<span class="mw-page-title-main">Toronto General Hospital</span> Hospital in Toronto, Ontario

The Toronto General Hospital (TGH) is a major teaching hospital in Toronto, Ontario, Canada and the flagship campus of University Health Network (UHN). It is located in the Discovery District of Downtown Toronto along University Avenue's Hospital Row; it is directly north of The Hospital for Sick Children, across Gerrard Street West, and east of Princess Margaret Cancer Centre and Mount Sinai Hospital. The hospital serves as a teaching hospital for the University of Toronto Faculty of Medicine. In 2019, the hospital was ranked first for research in Canada by Research Infosource for the ninth consecutive year. Since 2020, it has been ranked among the top 5 hospitals in the world by Newsweek.

<span class="mw-page-title-main">Kidney transplantation</span> Medical procedure

Kidney transplant or renal transplant is the organ transplant of a kidney into a patient with end-stage kidney disease (ESRD). Kidney transplant is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ. Living-donor kidney transplants are further characterized as genetically related (living-related) or non-related (living-unrelated) transplants, depending on whether a biological relationship exists between the donor and recipient. The first successful kidney transplant was performed in 1954 by a team including Joseph Murray, the recipient’s surgeon, and Hartwell Harrison, surgeon for the donor. Murray was awarded a Nobel Prize in Physiology or Medicine in 1990 for this and other work. In 2018, an estimated 95,479 kidney transplants were performed worldwide, 36% of which came from living donors.

Organ procurement is a surgical procedure that removes organs or tissues for reuse, typically for organ transplantation.

Certain fundamental Jewish law questions arise in issues of organ donation. Donation of an organ from a living person to save another's life, where the donor's health will not appreciably suffer, is permitted and encouraged in Jewish law. Donation of an organ from a dead person is equally permitted for the same purpose: to save a life. This simple statement of the issue belies, however, the complexity of defining death in Jewish law. Thus, although there are side issues regarding mutilation of the body etc., the primary issue that prevents organ donation from the dead amongst Jews, in many cases, is the definition of death, simply because to take a life-sustaining organ from a person who was still alive would be murder.

Organ trade is the trading of human organs, tissues, or other body products, usually for transplantation. According to the World Health Organization (WHO), organ trade is a commercial transplantation where there is a profit, or transplantations that occur outside of national medical systems. There is a global need or demand for healthy body parts for transplantation, which exceeds the numbers available.

Transplantable organs and tissues may refer to both organs and tissues that are relatively often transplanted, as well as organs and tissues which are relatively seldom transplanted. In addition to this it may also refer to possible-transplants which are still in the experimental stage.

In December 2006, The UK Government set up the Organ Donation Taskforce to identify barriers to organ donation and recommend actions needed to increase organ donation and procurement within the current legal framework.

Organ transplantation in Israel has historically been low compared to other Western countries due to a common belief that organ donation is prohibited under Jewish law. This changed with the passage of new organ donation laws in 2008. If two patients have the same medical need, priority will now go to the patient who has signed an organ donor card, or whose family members have donated an organ. This policy was nicknamed don't give, don't get. The law also defines "brain death" as an indication of death for all legal purposes, including organ donation. Additionally the law provides financial reimbursement to living donors for medical expenses due to donation and lost time at work. Organ trafficking is explicitly banned. Health insurance plans can no longer reimburse patients who go abroad to receive transplants.

The Ontario Online Donor Registry is a website where Ontario residents, age 16 and older, can register their consent to be an organ and tissue donor. This registry was created to help ease questions and ambiguities with organ donor wishes. The virtual registry also increases Ontario donations with increased accessibility. The registration process can be done through beadonor.ca. Online donor registries have also become popular in the United States, where one can register through Donate Life America; Malaysia, registering through their National Transplant Registry; and Saudi Arabia, registering through the Saudi Center for Organ Transplantation.

<span class="mw-page-title-main">Human Transplantation (Wales) Act 2013</span> United Kingdom legislation

The Human Transplantation (Wales) Act 2013 is an act of the National Assembly for Wales, passed in July 2013. It permits an opt-out system of organ donation, known as presumed consent, or deemed consent. The act allows hospitals to presume that people aged 18 or over, who have been resident in Wales for over 12 months, want to donate their organs at their death, unless they have objected specifically. The act varies the Law of England and Wales in Wales, which relied on an opt-in system; whereby only those who have signed the NHS organ donation register, or whose families agreed, were considered to have consented to be organ donors.

<span class="mw-page-title-main">MOHAN Foundation</span>

MOHAN Foundation is a not-for-profit, registered non-government charity organisation in India that works in the field of deceased organ donation and transplantation. MOHAN is an acronym for Multi Organ Harvesting Aid Network. It has offices in Chennai, Hyderabad, Bengaluru, Delhi, Mumbai, Chandigarh, Nagpur, Jaipur and information centers at Kerala and Imphal.

BC Transplant Society (BCTS) founded in 1985 is now an agency of Provincial Health Services Authority (PHSA) in the Canadian province of British Columbia that registers consent to be donors of organs for Organ transplantation.

The Trillium Gift of Life Network was an agency of the Government of Ontario responsible for the province's organ donation strategy, promotion, and supply. Ronnie Gavsie was the President & CEO. The agency maintained the popular BeADonor.ca website. It was subsequently subsumed under Ontario Health in 2019.

The current law in Ireland requires the potential donor to opt in to becoming an organ donor. However, it is ultimately up to their family to make the decision whether or not the person is allowed to donate their organs after they die.

Organ transplantation in the Indian state of Tamil Nadu is regulated by India's Transplantation of Human Organs Act, 1994 and is facilitated by the Transplant Authority of Tamil Nadu (TRANSTAN) of the Government of Tamil Nadu and several NGOs. Tamil Nadu ranks first in India in deceased organ donation rate at 1.8 per million population, which is seven times higher than the national average.

Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994. The law allows both deceased and living donors to donate their organs. It also identifies brain death as a form of death. The National Organ and Tissue Transplant Organisation (NOTTO) functions as the apex body for activities of relating to procurement, allotment and distribution of organs in the country.

References

  1. 1 2 Wilkinson, K.; Peet, D. (2014). "Organ donation". InnovAiT. 7 (2): 109–116. doi:10.1177/1755738013506565. S2CID   208183197.
  2. 1 2 "History of organ and tissue donation (2009)". Australian Government Organ and Tissue Donation and Transplantation Authority. Retrieved 31 August 2015.
  3. 1 2 3 4 "Organ and tissue donation by living donors, guidelines for ethical practice for health professionals (2007)". Australian Government National Health and Medical Research Council. Retrieved 31 August 2015.
  4. 1 2 3 "Organ Donation (2015)". Encyclopædia Britannica. Retrieved 31 August 2015.
  5. 1 2 Van Raemdonck, D.E.M., Rega, F.R., Neyrinck, A.P., Jannis, N., Verledenn, G.M., and Lerut, T.E. (2004). "Non heart beating donors". Seminars in Thoracic and Cardiovascular Surgery. 16 (4): 309–321. doi:10.1053/j.semtcvs.2004.09.014. PMID   15635535.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  6. ↑ "Organ Donation". U.S. Department of Health and Human Services. Retrieved 31 August 2015.
  7. ↑ "Organ and Tissue Donation Frequently Asked Questions". NSW Government Health. Retrieved 31 August 2015.
  8. ↑ Delriviere, L.; Boronovskis, H. (2011). "Adopting an Opt-Out Registration System for Organ and Tissue Donation in Western Australia". Parliament of Western Australia. Retrieved 31 August 2015.
  9. 1 2 Coppen, R., Friele. R.D., Marquet, R.L. and Gevers, S.K.M. (2005). "Opting-out systems: No guarantee for higher donation rates". Transplant International. 18 (11): 1275–1279. doi: 10.1111/j.1432-2277.2005.00202.x . PMID   16221158.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  10. ↑ Perry, A.G.; Potter, P.A. (2004). Clinical nursing skills and techniques (5th ed.). St.louis, Missouri: Mosby/Elsevier. p. 1254.
  11. ↑ "Organ and tissue donation policy". Australian Medical Students Association. Retrieved 31 August 2015.[ permanent dead link ]
  12. 1 2 3 4 5 Oliver, M., Woywodt, A., Ahmed, A., and Saif, I. (2011). "Organ donation, transplantation and religion". Nephrology, Dialysis, Transplantation. 26 (2): 437–444. doi: 10.1093/ndt/gfq628 . PMID   20961891.{{cite journal}}: CS1 maint: multiple names: authors list (link)
  13. ↑ "2013-2014 Annual Report". Australian Government Organ and Tissue Donation and Transplantation Authority. 2014. Retrieved 31 August 2015.
  14. ↑ "Patients Listed for Solid Organ Transplantation Statistics 2013". Australian Government Organ and Tissue Donation and Transplantation Authority. 2013. Retrieved 31 August 2015.
  15. 1 2 Australian Government Organ and Tissue Donation and Transplantation Authority (2014). Annual Report.

Australian Organ Donor Register

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