Otago Daily Times - 19 June 2004

Better approach urged to human organ donations

More than 350 New Zealanders are waiting for a kidney transplant and wondering where their life-saving organ will come from.

The New Zealand Kidney Foundation's Kidney Awareness Week, which began last Monday and runs until next Wednesday, is highlighting the anxious wait these people have and the restrictive health regime they have to endure,

Dunedin scientist Dr Jock Allison (60), who is having dialysis treatment while awaiting a transplant, said there were New Zealanders willing to be donors and kidneys could be made available from victims of fatal accidents. However, access to these organs was restricted by a poorly administered donor programme labouring under staunch political correctness, he said.

It may seem callous to eagerly promote access to people’s organs but when implanted in sick people, they could save the New Zealand health system millions of dollars.

Dr Allison well knows the trials of malfunctioning kidneys. His family has a substantia1 incidence of polycystic kidney disease and he has been on dialysis for 10 months.

His recent  submission to a Ministry of Health discussion document reviewing regulations on human tissue therapies led him to investigate the issue of organ donorship in this country.

"There is no argument that New Zealand has one of the lowest organ donor rates in the western world, and the demand for organs is increasing." Dr Allison said,

Areas needing attention within New Zealand's organ donorship programme were the lack of a comprehensive system, which would ensure the wishes of potential donors were followed, the economic impact of the lack of available organs and the need for sensible compensation for live kidney donors, he said.

Dr Allison regards as inadequate the present system of people signalling their intention to donate body parts by ticking the box on driver's licences.

After an accident, the victim's family members could give permission for organs to be used or could

override the desires of a potential donor.

Even the simple chore of asking permission was often neglected, he said.

Dr Gillian Durham, of the Ministry of Health. informed a Dunedin meeting that only 70% of potential donor families were asked and, of these, only 55% agreed. The result was only 38% of potential donors were actually considered.

Dr Allison advocates a comprehensive database of people wanting to donate organs and for hospitals to accept that as implying consent.

"The driver's licence system meets none of the above criteria. In fact the general public are very poorly informed about the whole area of organ and tissue donation.

The subject of better education of the general population and derivation of a more useful and comprehensive database should be the subject for a working group to research and come back with detailed recommendations.

Apart from the obvious life-restoring benefits a new organ provides, the cost benefits of relieving New Zealand’ s health system of people requiring intensive care are large.

In an analysis of kidney transplants. Dr Allison deduced that a family denying permission to use both organs cost the country about $880,000.

This figure comess from adding the continuing health care costs. such as dialysis treatment for people awaiting transplants, and does not take into account the value of other organs made available from each donation, which would tip the savings to more than $1 million.

"While it may be considered that assessment  of family decisions whether to allow recovery of organs for transplantation from a loved one, in this light, might be mercenary and unfeeling, the point is that for every refusal to allow recovery, the cost to the nation will be very high indeed.

"Where else in the economy would an individual or family be allowed to make a decision without question which would result in a cost to the state in excess of $1 million?�?

Kidneys are in a different category to other organs because one can be taken from a live donor.

Ian Eckford (53), who lives near Frankton, is enjoying life thanks to a kidney gifted to him from his wife Barbara, (52).

However, there was little recognition from the Government for the cost-saving procedure.

No compensation was given for the loss of work time during the minimum five to six week recovery from the operation.

Mrs Eckford was sent home to recoup under the guidance of a GP while Mr Eckford was closely monitored by the hospital.

Mr Eckford said there needed to be better acknowledgement of live donors, their commitment in time and money and the sacrifice of offering an organ.

Education of the process would help enormously, he said.

Dr Allison said without considering the value of the improved quality of life and improved productivity to the country, the national savings in health costs for every live kidney donor was at least $500,000.

He suggested live donors should quali1fy for full costs during the assessment phase of consideration for donation, and, in the event of donation, become eligible for a payment of $10,000, which would allow for lost wages, pain and family dislocation during the operation period.

 Another issue causing concern is public attitudes to medical uses of organs, There was a public outcry  when it was learned an Auckland hospital had retained organs from patients who had died there many years earlier, using them without consent from family members.

As a result of that and other incidents, pictures of organs were now used in medica1 teaching rather than students practising on the real thing, Dr Allison said.

He had been advised to select a medical expert who looked older than 40, a doctor who would have trained on the real thing,

Attitudes to the use of human tissue vary greatly in New Zealand. While people could be devastated to find a loved one had been buried without a heart or other organ, there is little crying over spilt blood or the giving of blood to help others.

No-one queries the natural shedding of skin nor the cutting of hair when it is swept away and unceremoniously disposed of.

Then there is that matter of a person' s teeth, gallbladder, tonsils and inflamed appendix. Where do they go after surgery?

As part of Kidney Awareness Week, the Dunedin Hospital dialysis unit, situated on the third floor, will be open to the public tomorrow from l0am to 4pm.