The limits of Kiwi generosity

How many times have we heard in praise of someone, "he would give you the shirt off his back"? Generosity is one of the defining characters of this country and its people. Indeed, since colonial days, the great majority of this country's citizens have been willing to lend a helping hand to those in need.

But while this trait covers many areas of support - within the extended family, neighbourhood, helping with school and sport activities and elsewhere in the community, and to giving national and overseas aid - it has its limits. One of these is our willingness to donate body parts when we die. New Zealand has one of the worst records in the developed world for organ donation. New Zealand's annual donor ratio is about 10 people per million, far less than Spain's 32.5 or the United States' 22.3. In the United Kingdom, the ratio is 13.4.

Many patients die on waiting lists unnecessarily because organs are not made available. In 2003, 37 people received life-saving liver transplants, but seven patients died waiting because there were no organs. Another three became too sick for operations and died later. Some 350 people are waiting for kidney transplants, many receiving costly dialysis treatment, not knowing when a new kidney will become available. Typically, they wait two to five years and demand is growing. Only 60 to 70 transplants, excluding those from live donors, are carried out each year.

How can this often fatal flaw in our national psyche have come about, and why do we allow it to continue? Partly, it is probably because many people prefer not to confront death, or any aspects of it, until it confronts them in some way - through the death of a loved one, relative or friend. In many cultures, there is an added sensitivity towards the human body, despite the fact that in death someone's body parts can save or enhance the life of other human beings. But mostly, it is the woefully inadequate process in New Zealand through which potential donors indicate their willingness to give. The system of ticking a box on drivers' licences to signal intention to donate organs is flawed in many ways: it only applies to drivers (57 per cent of whom are specified as non-donor); there is no regular education or review on organ donation options; updating details, such as willingness to donate organs, costs $30; the organ donor database does not clearly define donors' wishes and is unsatisfactory in other ways.

The Government is looking at changing the system and revising our laws, but progress is slow - too slow. Health Minister Annette King, after asking in April 2002 for the setting up of a comprehensive national donor database to be investigated, has put off its establishment until there is more research. She argues a comprehensive database might not in itself boost donor rates. Among the most effective law changes being considered, however, is one towards "presumed consent". Organs would automatically be available unless a person officially registered an objection. Such a system would better reflect the duty of care and generosity of spirit that as individuals and communities we profess to have. While individuals must be allowed to opt out, the Government needs to take a strong hand in leading attitudes, particularly so that informed decisions have been made in advance of sensitive times, such as after a fatal accident.

It can be acknowledged the Government has recently introduced some financial compensation for live donors and is in the process of creating a new agency, Organ Donation New Zealand, to give a national focus to organ donation, but much more progress is needed, and quickly, if lives are to be saved. The organ donor system has failed to keep pace with medical developments, need and, probably, prevailing attitudes. Most importantly, there should be widespread, informed and open discussion within the community about this most vital of issues.