Plan to widen organ harvest rules

Organ Donation New Zealand is considering broadening the donor criteria in a bid to improve low donor rates. It hopes to use the knowledge of an American surgeon experienced in the area, who is starting in Auckland in April, to establish the protocols required.

The plan was also likely to go to public discussion, national donor coordinator Janice Langlands said.

New Zealand has a dire donor organ shortage, with only 29 people donating last year – the lowest number in more than 10 years of records. The shortage is so bad that surgeons have resorted to accepting old or diseased organs they would have turned down a decade ago.

At present, only patients certified as brain-dead – who can no longer breathe for themselves – can become organ donors. However, another group of intensive care patients could also donate usable organs, but are not deemed eligible.

Those patients may be breathing for themselves but have no prospect of recovery. Treatment is usually withdrawn after discussions between doctors and family.

Such patients are known as non-heart-beating donors because, unlike brain-dead patients whose organs are retrieved while the heart is still beating, these patients are first allowed to die before their organs are removed.

Australia and Britain have been using this category of donors for some time, particularly for kidney transplants. Livers and lungs can also be transplanted.

Kidney and liver programme director Stephen Munn said the team was "very interested" in using non-heart-beating donors. However, he expected it would take about a year to set up the necessary systems and ethical protocols.

The main disadvantage of that category of donors was that the organs could be of lower quality, reducing survival and function rates.

The British Transplant Society advises that non-heart-beating donor transplants should go ahead only if the recipient is told, and agrees to, "the increased risk of delayed organ function and somewhat poorer overall outcome".

Intensive care specialist Peter Hicks said the poorer quality of the organs was one factor that made intensive care doctors reluctant to use non-heart-beating donors.

In the case of brain-dead donors, a cooling preservative solution is run through the organs while they are still working.

For non-heart-beating patients, however, doctors have to wait till the patient dies – then have a stand-down period of at least five minutes before preserving the organs – during which they can be damaged.

Using non-heart-beating donors also raised emotional and professional issues, Dr Hicks said. Death was not predictable, which could be difficult for families.

"It can be unpleasant sitting waiting for someone to die."

The fact New Zealand was considering the practice was a sign of just how bad the shortage had become, Dr Hicks said.

An editorial in this week's British Medical Journal, by Leeds-based transplant surgeon Raj Prasad, called on all transplant services to consider the practice to help bridge an ever-increasing gulf between organ demand and availability.

He estimated using livers from non-heart-beating donors could increase organ supply by up to 20 per cent.

Organ donation campaigner Andy Tookey, whose four-year-old daughter Katie suffers from a rare liver condition and will need a liver transplant, supported the use of non-heart-beating donors.

He wanted the criteria extended further to include patients who died in hospital but outside intensive care, usually of a heart attack.