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Inconsistent organ transplant decisions sparks review

Stuff - 19 May 2015

The system that determines which patients get a lifesaving organ transplant is ethically questionable and could lead to "false hope", a report says.
The National Ethics Advisory Committee has raised concerns about the organ donor system in New Zealand, sparking Associate Health Minister Peter Dunne to order a review.
In a report released this month, the committee said there seemed to be no consistency around deciding who received an organ and many patients appeared confused about why they were, or were not, receiving a potentially lifesaving transplants.
There was also unequal access to transplants, with Maori and Pacific people less likely to receive a replacement organ.
"It is unclear how the competing principles ... are being weighed against each other," the report said. "Allocation decisions need to be ethically defensible as deceased donor ... organs are a community-held resource."
It also raised concerns about the how people were treated once they were on the waiting list, particularly the hundreds waiting for a new kidney. Most wait for three years for a new kidney but many have been taken off the list because they have become too sick to be eligible, or have died.
With 600 patients of the kidney transplant list, 170 added a year and only 110 kidney operations performed each year, the gap would only get worse, the report said. This could create a widening disconnection between patients' expectations a new kidney and the actual "very low chances of being transplanted".
"Some stakeholders have raised an ethical issue of whether these people live in 'false hope'."
The report was welcomed by Kidney Health New Zealand, with chief executive Max Reid saying it reflected the anecdotal evidence the organisation had gathered from doctors and patients.
"The criteria do appear to be applied inconsistently across DHBs," he said.
"There are also questions of transparency. How do people know they are all being treated in the same way?"
New Zealanders have one of the worst organ donor rates in the developed world, being less than half Australia's and even further behind many European countries.
Despite the Government recently trumpeting a record number of transplants and increased funding, the number of dead donors had risen from 40 in 2003 to just 46 last year.
Many of the countries with higher donor rates forced people to opt out of organ donation, rather than requiring them to opt in, as New Zealand does.
"We are something like third to the bottom in the developed world, which is simply unacceptable," Reid said.
Dunne said two separate reviews were being carried out into organ donations, one focusing on the concerns raised by the committee and a broader investigation into ways to increase donor rates. Options being considered included removing a family's bedside right to override a deceased relative's consent to be an organ donor.
While issues of transparency and unequal treatment raised by the committee were important, there were all contigent on getting enough organs, Dunne said.
"All of this is predicated on organs being available, and we don't have a particularly high rate of organ donors in New Zealand."
– You can donate your eyes, skin, liver, kidney, pancreas, lungs and heart.
– You can indicate that you want to be a donor on your driver's licence, but that can still be overruled posthumously by your family.
– If you need an organ, you need to be referred to a transplant unit by a specialist and undergo medical and other tests to determine your suitability.  
– To make the list, you need to be sick enough to need a new organ but generally health enough, without other complicating conditions, to have a decent likelihood of surviving for at least five years with the new organ.
– Last year there were 175 organ transplants, the majority of them kidney transplants.
 - Stuff

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