Potential organ donors being blocked by family and doctors, says audit
Stuff - 2 March 2016
When Wellington man Michael Boyes died suddenly in February, his family honoured his last wishes, donating his organs to help seven strangers.
Many organs that could save lives are not making it out of the hospital, with reluctant families being the biggest barriers.
An Organ Donation New Zealand audit, released under the Official Information Act, shows intensive care doctors often do not discuss potential organ donation with brain-dead patients' families.
Even when they do, six out of 10 families refuse.
The audit comes after the death in February of young Wellington man Michael Boyes, whose family honoured his wishes and donated his organs to save the lives of seven strangers.
* Michael Boyes donates organs to save the lives of seven others
* Uncertainty about organ transplant waiting lists
* Organ donation - the gift of a lifetime
* Wellington woman's death brings life to five others
* Waiting for a kidney
* Inconsistent organ transplant decisions sparks review
* Organ donation review will look at cultural barriers
New Zealand has one of the worst organ donation rates in the developed world, particularly among dead donors.
Organ donor campaigner Andy Tookey gives evidence to a select committee in 2007 with daughter Katie, then 5, who needs a new liver. She is still waiting, nine years on.
The way donors are managed, both alive and dead, is the subject of two government reviews expected to report back this month.
Long-time donor campaigner Andy Tookey, who obtained the audit, said the figures showed the donor system was a "complete mess".
"I think the biggest problem is it doesn't matter how many donors they find, if six out of 10 families say no."
To donate organs in death, a person needs to have died in an intensive care unit, usually from a brain injury or occasionally a heart attack, which allows doctors to keep their organs alive after the patient's brain is dead.
The audit shows that, last year, in a third of such cases, doctors never ran the necessary tests.
Of the 135 times when organ donation was raised with families, on only 53 occasions did they consent to give up their loved one's organs.
James Judson, a medical specialist at Organ Donation NZ, said there were legitimate reasons why a possibly brain-dead patient would not be tested, such as damage to their organs, or the family already ruling out donation.
However, he said some ICUs were better than others at bringing up organ donation with a patient's family.
"If you're confronted with a family that is already devastated, there can be the tendency to think, they have suffered enough ... but the most competent person should be asking the family every time.
"If you don't have that conversation with the family, you're not going to get a 'yes'."
But Tookey said families were being asked at the worst possible times in the worst ways, and not being followed up after they refused.
"You are saying, 'By the way, your son has died in a car crash, can we have his organs?' "
In Spain, families were asked repeatedly to donate by a range of people even after they refused, and 85 per cent eventually agreed.
"It's not about stopping the family saying no, it's about making it a lot harder for the family to say no," Tookey said.
But Judson said many of the pressure techniques used in Spain would be considered coercive n New Zealand, and the focus should be on improving how, and how often, families were asked to donate.
However, New Zealand still had a way to go to catch up with Australia or Britain, which both had higher rates of family consent.
"The most important factor is what happens in ICU, what the doctors and nurses decide to do."
Doctors did not check patients' driving licences "because we don't consider it informed consent. The family should be asked irrespective of what's on the driver's licence".
This was despite research from Australia showing knowledge of a deceased family member's preference to donate drastically increased the chance of their family providing consent.
WE NEED TO TALK ABOUT IT
Chris Poynter starts some of hardest conversations in a hospital, asking grieving families for their consent to donate a patient's organs within minutes of their death.
He is a link doctor for organ donation at Wellington Hospital's intensive care unit, which last year had more organ donations from dead donors than anywhere in the country.
The approach was always the same, he said: the families were asked to put themselves in the shoes of their loved ones, and think about what they would want, rather than their own wishes.
Poynter said it was still hard to predict how the conversations would play out. "A lot of people are being introduced to this concept for the first time, and at a time of extreme distress."
Doctors must balance the needs of the family, and the deceased patients' care, against other patients whose lives might rely on those organs to live.
Poynter said he felt a heavy responsibility to waiting organ recipients, "but we make a special point of not trying to corral people into making a decision because, while we want more donors, our priority is the patient in front ot us".
Whether this was the right balance needed to be part of a wider ethical conversation with the public, he said. "It would be great if the New Zealand public as a whole could have more discussions about organ donation."
* 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. In fact, unless your family asks, doctors won't even check your driver's licence.
* Only four out of 10 families consent to an organ donation in New Zealand. That compares to about six out of 10 in Australia and Britain.
* Only in very unusual circumstances can anything other than a kidney be extracted from a dead donor. The donor must be brain-dead, but their body still functioning, for other organs to be removed and transplanted successfully.
* Last year there were 53 dead organ donors, with the number rising steadily but slowly from 29 in 2005.
* Wellington Hospital ICU provided 12 dead organ donors last year, the single largest source in the country.
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