Patients die as doctors fail to ask for organs 
 
By Kim Ruscoe & Martin Kay, DOMINION POST and STUFF.CO.NZ
(reproduced by kind permission of INL Interactive)

15 August 2002 -- Donor organs are being lost because doctors will not approach bereaved families - even though patients are dying while waiting for transplants.

Three hundred New Zealanders are waiting for donor kidneys, 15 for livers, nine for hearts and three for lungs, but only 40 brain-dead patients are made available each year for organ donations.

A national study has found that 104 of the 1404 people who died in intensive care units between April 1999 and March 2000 were suitable donors but only 38 donated organs.

Doctors shied away from asking for consent from the families of 35 potential donors and 31 families refused consent, the study reveals.

The study highlighted the need for doctors and nurses to be trained to approach bereaved families, the Health Ministry and senior clinicians said yesterday.

Wellington Hospital intensive care medical director Peter Hicks said many doctors felt uncomfortable discussing organ donation.

"It's a bit daunting, sitting down with a family and telling them their loved one is brain dead," Dr Hicks said. The reluctance of doctors to seek organ donations drew a call yesterday from Wa********* diabetes patient Jason ***** for the families of all possible organ donors to be approached.

Mr *****, who has been waiting for a kidney and pancreas transplant for two-and-a-half years, said much more needed to be done to help people who needed organs.

"You see the ad on television where they ask for blood for the blood bank but you never see them advertising for organs.

"Every family should be approached (after a death). The family can say yeah or nay -- that's up to them -- but they should all be asked."

Wellington Hospital renal physician Grant Pidgeon said the number of patients needing kidney transplants rose annually while donor organs had remained static for the past five years.

Since 1998, 15 people had died waiting for liver transplants. New Zealand has one of the lowest organ donation rates in the world, despite 1.1 million people having indicated on their driver's licence that they want to be donors.

Health Ministry spokesman Colin Feek said the ministry had begun funding education programmes for intensive care doctors and nurses to raise the organ donation rate.

Janice Langlands, of the National Transplant Donor Co-ordination Office at Auckland Hospital, said international studies showed that training doctors had the greatest impact on donation rates.

"I don't think you would find any doctor in New Zealand or in the world who found approaching the family ( of a brain-dead patient ) easy," she said.

Some families could not even understand the concept of brain death and did not believe their loved one was dead.

Dr Hicks said that while people could have their wish to be an organ donor stated on their driver's licence, the decision ultimately lay with the family.

"Some people can't bring themselves to let it happen. In this situation we don't allow the donation to go ahead because we don't want to be seen to be distressing families."

While some had called for the driver-licence donor scheme to be made legally binding, Dr Hicks said forcibly removing a family's loved one could jeopardise the whole programme.

"None of us are prepared to go against the family's wishes," he said.

Dr Feek said legislation around organ donation was being reviewed by the ministry.

"The review is likely to be a lengthy process and preliminary advice will be provided to the Health Minister later this year."

The ministry's education programmes were targeting doctors and nurses in intensive care units.

"Our advice is that this is where we should be focusing our efforts to improve organ donations," Dr Feek said in a statement.

However, he said the most effective way to ensure more organs were donated was for families to discuss the issue before decisions needed to be made.

The study was yet to be published but it was hoped it would appear in a medical journal shortly, Dr Hicks said.

The authors of the research were James Judson, Lynette Newby, Janet Roberts, Dr Hicks and Auckland Hospital's Stephen Streat.

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