Primary duty to save lives
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Thu, 9 Jun 2016
Our sensitivity to the immediate grief of the families of the dying seems to be letting others die. New Zealand's organ donation rates are appalling and decisive action is needed to save lives.
For too long, this country has pussy-footed around the issues, and this approach is showing little sign of change. The Ministry of Health, while proposing changes to the donation system, has shied away from backing a binding register.
It could, also, have supported "opt-out'' consent, where organ donation permission is given by default.
In declining to propose a binding register, the ministry said clinicians strongly objected to taking donor organs against a family's wishes when such registers have been proposed previously. They have a point. Imagine the difficulty when a family vehemently opposes organ donation but it goes ahead.
That is what could happen in Austria, with its "hard'' opt-out process. If someone has not specifically recorded an objection, organs are removed and family wishes can be overridden.
But what a difference opt-out makes. Austria is quoted as having a 99% donor rate, while opt-in Germany, with a similar culture, has 12%. There is a middle course, the "soft'' opt-out, practised in Spain, along with other measures.
Its donation rate per million people is 36. New Zealand's, one of the worst if not the worst in the Western world, although rising, is below 12.
Wales introduced soft opt-out last December. People can still record their objection and that will be heeded. Others record their "express consent'', and the default for everyone else is "deemed consent''.
Doctors still need family involvement. The argument is family members will need to provide lifestyle and medical information to help check the quality and safety of donated organs. At that time, families have veto options.
The Ministry of Health accepts it will be worthwhile examining what happens in Wales. But, in its examination of the relative successes of Spain, Croatia and Portugal, it claims reasons other than opt-out play the crucial roles.
It cites the president of Spain's National Transplant Organisation, ignoring the fact he has an interest in giving credit to Spain's other supportive measures and systems.
The ministry also cites Australia as lifting its rates through various means from 11.4 per million in 2009 to 16.1% in 2014, a 41% increase. While that can continue to rise, 16.1% is still far too low, and therefore not entirely an example to follow.
Improvements, although limited, have been made in New Zealand in the past few years, backed by more money. Unfortunately, judging by the proposals, it looks as though all New Zealand might gain is relatively wishy-washy changes.
These include making it easier for people to change their donor status, a public awareness campaign, specialist donor staff and more specialist training and a new co-ordinating body. Although such recommendations need to be part of the package, strong action is required.
One study shows opt-out countries have 25% to 30% higher donation rates. Another, of 17 European countries, found a 16.3% rise when donation is the default.
Maori and Pasifika donation rates are especially low, even though the need for donated organs is higher. There are all sorts of reasons for this, a situation common for minorities in most of the West. These need to be addressed, although default consent should help. It makes it clear what the norm should be.
In the absence of express objections, the expectation must be, even in that fraught situation when a loved one is on life support or about to die, that organs will be donated. In the face of acute distress, that might be tough for respectful doctors and upsetting for families.
Short-term difficulty, however, should not stand in the way of the primary duty to save lives.
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