Pushing boundaries on organ transplants

13 September 2005

Organ transplant is an emotional minefield, The Dominion Post writes. It asks people who are trying to deal with the trauma of confronting death to put aside their shock and grief, and make the decision to allow organs to be harvested for use in others, and it asks doctors, already bearing the worst of news, to make that hard request. Unsurprisingly, research shows that some doctors have found that too much, and the families of some potential donors were never asked.

Donor rates in New Zealand are low. Last year, there were 9.8 donors per million New Zealanders, 40 altogether.

The pool of potential donors is small anyway. Donation is only possible when a person is brain-dead and on a ventilator in an intensive care unit in hospital. In most cases, donors have died from a head injury or from bleeding in the brain.

In one of the macabre ironies which surround a system that depends on people dying to save lives, the falling road toll seems to have cut the number of younger donors.

Against that background, the news that New Zealanders are getting less than ideal organs in transplant operations is little surprise. Surgeons are taking organs from donors who would have been rejected just a few years ago, and are pushing the boundaries.

In the future, the issue is not likely to be so huge. The possibility of xenotransplantation – the process of transplanting organs from one species to another – is becoming more realistic. Scientists have succeeded in genetically modifying pigs to overcome many of the potential immunological problems involved, such as transplant rejection, though there are still problems including the possibility of animal viruses crossing over and infecting humans to be solved.

In the meantime, the problem is to make the system work better, especially the consent progress. Currently, the decision people make when they get a driving licence counts for nothing. It is not considered a proper consent, and the whole process starts from square one with the family. Under a new scheme, those who opted to become donors would be sent information about donation and a consent form. If they became brain-dead in intensive care, families would be asked to confirm the brain-dead person's choice, rather than if they wished them to become a donor.

Organ donation campaigner Andy Tookey wants to go further and remove the right of the family to block a donation if the donor had earlier given consent.

Mr Tookey has also suggested linking access to organs for transplantation to a person's willingness to be a donor. He proposes that those who had not registered as donors should go to the back of waiting lists.

That may seem harsh, especially to Maori, who have cultural reservations about taking organs from the dead, but there is a strong element of justice to it. Those whose beliefs preclude them from being donors are on thin ice ethically if they then argue they should be entitled to transplants.

However, the key to increasing the number of donors lies in creating a system where people are given the chance to make an informed choice to be donors, and that if they take that option, all those involved – the medical professionals and the families – know and respect their wishes. That rests more on education than on anything else