Editorial: Donor's say should be sacrosanct

26.02.2004

Jonah Lomu has been a powerful image for the game of rugby around the world and for a brand of sportswear. Now, as he hopes for a kidney donor to relieve him of a debilitating disease, he could become a compelling image, in this country at least, for a new cause. New Zealand is said to have one of the lowest rates of organ donation in the developed world. Up to 350 people are normally on the waiting list for organ transplants, most of them for kidneys. But for the past decade the donation rate has fluctuated between 34 and 46 organs a year.

Among Maori and other Polynesians the donation rate is even lower. Of the 389 bodies from which organs were transplanted in this country over the decade, only 13 were Maori and four were Pacific Islanders. The reason is said to be cultural. Yet Maori and Pacific Islanders are more likely than other New Zealanders to need organ transplants. They suffer disproportionate rates of renal disease and need Polynesian donors. When it comes to tissue matching, ethnicity matters.

The Government aims to improve the overall donation rate by half with a series of steps announced on Tuesday. The national donation agency, based at Auckland City Hospital, will be expanded and given an enlarged budget of $700,000 a year. One of its first tasks will be to survey public opinion on the delicate question of whether a donor's intentions can be overruled by family members at the deathbed. In principle the answer seems easy. If a deceased person has declared his or her organs available for transplant, that is a decision that ought to be respected by family members and everybody else.

Yet it is easy to understand how medical professionals have come to allow family members a veto. In the trauma of emergency rooms, where suitable organs are most likely to become available, nobody would want to argue the point with grief-stricken relatives.

Another of the tasks of the expanded agency will be to give doctors and nurses in intensive care wards more training in organ donation issues, which presumably means the techniques of seeking family consent. But it would seem kinder to all concerned - including the families - if the law simply removed the possibility of a veto. It would be kinder to loved ones if they knew a valid declaration of the deceased was the final word on the subject.

In response to a 1169-signatures petition promoted by Aucklander Andy Tookey, whose daughter is likely to need a liver transplant, Parliament's health select committee has suggested an organ donor register linked to the driving licence database. The Government initially rejected the idea citing "ethical problems" with registers in other countries. It also found little evidence that they increased donor numbers, which might be so but at least formally registered declarations would be more reliable than a smudged word on a grimy licence.

The decision to be a possible organ donor should be more than an afterthought on a driving certificate issued long ago. It should be a considered statement properly witnessed and recorded by the national donation agency. The driver's licence should continue to record the decision, too, but only as an indication to doctors that a potential donation is available.

Once the declaration has been confirmed from the agency's register, relatives should not be able to overrule it. And that goes for families of any culture. If the deceased did not let cultural considerations override his or her personal gesture, it is reasonable that relatives should have to accept it. Cultures do not own individuals; individuals adhere to cultures to the extent they feel the need.

Meanwhile, Jonah Lomu's case will have captured public attention. His ordeal will be closely followed and may bring the sort of public response that could help all awaiting a life-saving donation.