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Monday, 18 June 2007

Organ-donor study delayed

A study into low organ-donor rates has no government funding and no ethical approval two years after planning for it began.

New Zealand has one of the lowest organ-donor rates in the world, with six donors per million people compared with 10 and 11 per million in Australia and Britain respectively.

The United States has 21 donors per million people.

There is growing public and political pressure for an organ-donor register to replace the tick on a driver's licence where people can indicate their wish to be a donor.

Supporters say a register would boost donor rates by ensuring a person's wishes were known by medics and families.

But opponents say such a register would be expensive to run with little impact on donor numbers.

Both sides believe an audit of every death in hospital intensive care units (ICUs) – proposed by Organ Donation New Zealand in its 2005 annual report – would explain what is happening.

National MP Jackie Blue said she was "shocked" the study was yet to begin.

"Here we are in mid-2007 and they haven't even started it. To me it is almost negligence, quite frankly," she said.

A 2001-02 audit found that of 104 potential donors – patients who suffered brain death in an ICU – only 38 became donors, she said.

Blue, whose private member's bill – the Human Tissue (Organ Donation) Amendment Bill – seeks to set up an organ donor register, said the audit showed 35 families were not even asked about organ donation.

Organ Donation New Zealand clinical director Dr Stephen Streat said setting up an ongoing national audit was hugely complex.

It required not only funding and ethical approval but also the design and installation of a new computer system and, crucially, the support of staff in every ICU.

Staff at every unit had agreed to contribute to the audit, despite there being no personal gain, yet ran the risk of considerable political flak.

"This data could be manipulated against them," Streat said, if an opportunity for donation was missed.

The audit would collect details on the 150 to 200 patients a year who died in an intensive care unit, whether they were suitable for organ donation, and what was discussed with families.

A revised audit proposal was also awaiting final approval from the Ministry of Health's multi-region ethics committee.

"In all other respects the study is ready to commence," Streat said.

Pharmaceutical giant Roche, which sells immunosuppressant drugs, has agreed to fund the $40,000 start-up costs and running costs of up to $30,000 for the first three years of the audit.

Streat said there was no systematic evidence that organ donation registers increased donor numbers.

"The incredibly single-minded, blind determination to focus on a register is really focusing an enormous amount of effort and energy on something which is a tiny component of organ donation and probably makes a difference less than 5% of the time," he said.

The decline in the road toll and the ability of ICUs to prevent brain death were more significant factors. He added the relatively small number of donors meant rates fluctuated from year to year.

The Health Ministry's national ethics committees co-ordinator Sally Cook said the audit had been approved by the committee, subject to certain conditions.

Organ Donation NZ's response to these conditions was under review.

The committee meets today to consider a second application from Organ Donation NZ for approval to use organs after cardiac death.

Currently, organs are taken only from patients suffering brain death.

If approved, it could see another one to six donors a year.

Courtesy of STUFF www.stuff.co.nz

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