Otago Daily Times - 13 May 2004

Transplant debate ignores most concerned

YOUR excellent editorial on New Zealand's very low organ donation rates was very timely. Being on dialysis and waiting for a kidney, my interest in the subject has intensified somewhat in the last 12 months.

The present situation, where, from 100 potential donors, only 70% of families are asked about the possibi1ity, and of these only 55% agree, means that only 38% of potential donors are identified. C1early "presumed consent" or the individual’s wishes must be obeyedâ€? could improve our very low donor rate.

The present consultation process, being undertaken by the Ministry of Health. is really consultation with the medical and technical industry associated with the transplant part of medicine, rather than with the general public for Whom the results of the consultation, law changes and an increased donor rate, are so important.

 At the Dunedin meeting there were four only from the public, outside a medical focus. At a recent meeting in Auckland, attended by 60, there were no attendees from the donor/recipient (i.e. had a transplant), or waiting (on dialysis or requiring another organ) groups at all.

The relevant section of the 140-page ministry report, on which the consultation is based, includes

options for the donation of organs in future; i.e. presumed consent or other specification, and this is covered in seven pages only. The general public - if they knew about the consultation at all - couldn’t be bothered with reading the whole document.

The document has no information about the economics of the various options and the obvious economic advantages of a greater organ donor rate. Further, there was no mention of any payment for live donors,

Be they family members or altruistic donors.

Renal dialysis costs about $30,000 a year if undertaken at home, and about $55,000 if undertaken in hospital. Medical costs following transplantation are only $7000 to $8000 a year from 18 months, i.e. a saving to the health budget of $22000 to $45,000 a year per patient, not to mention an incredible lift to the quality of life for transplant recipients. The life expectancy of transplants is now considerable.

with many going beyond 20 years and continuing. At present. economics doesn’t rate a mention in comparison with a number of social and cultural issues which receive careful consideration.

In addition, there is no mention of payment for live donors. At present, any person who donates a kidney has to go through a four-week Winz stand down before becoming eligible for any payment, The policy makers at the ministry could well consider a $5000 to $l0,000 payment for a living donor on the basis that, to encourage an increase in this category, there should at least be no cost to the donors, and a

modest reward would surely be acceptable without the PC brigade having conscience problems making  them    think the organs are being traded for money.

It is not satisfactory that the ministry is having its consultation, in effect “in secret� from the general population, for which a change in policy is necessary and required. Thus we have a situation where the medical profession may well determine what is best for all of us. In fact, at the end of the Auckland consultation meeting, An Auckland surgeon, spokesman for the transplant doctors stood up and said it did not matter what law change came in, the doctors would not abide by it and would go with the wishes of the families.

When we have such breathtaking arrogance from some in the medical profession, it will continue to be difficult to increase organ donation rates. Unfortunately, we don’t all have quite the profile of Jonah Lomu, who you correctly identified, is doing a wonderful job as an ambassador in this area.

• Dr. Jock Allison is a Dunedin Scientist, Farmer and Businessman.