ORGAN DONATION - Full extract 

A lot of people find organ donation a difficult subject to discuss, a bit like talking about death or making a will. Perhaps this is because at the time one or more people are receiving a donor kidney or heart, another family is suffering a tragic loss. However, it is a vital issue that affects thousands of Australians. 

Transplantation has gradually become the accepted treatment for a number of conditions where organs like the kidneys, heart and liver have irreversibly failed. Patients with kidney failure who have dialysis several times a week are then able to return to a completely normal life. For patients waiting for liver and heart transplants it is the only chance of continuing life. Corneal transplants are another important procedure, restoring sight to many people. 

The techniques of transplantation and the treatment that follows have now been refined to the point of being fairly straightforward. The big problem is a critical shortage of available organs. The current Australian organ donor rate is 12 per million population, the lowest in the western world. The Victorian organ donor rate in 1992 was an even more disappointing 9 per million. 

Currently in Australia there are about 1500 patients waiting for kidney transplants. The average waiting time on dialysis before receiving a kidney has now extended to three years. There are also about 200 patients waiting for heart, lung and liver transplants; most of these patients spend a lot of their time in hospital and at least 20% will die before their operation comes up. 

The cost effectiveness of transplantation is impressive. Dialysis costs the community betweeen $30,000 and $50,000 per year for each patient. On the other hand a kidney transplant costs $18,000 in the first year and then just the cost of medication thereafter. Another important aspect is that the person is usually able to return to work. 

The vast majority of Australians are very supportive of the principles of transplantation. However, there are a few common misunderstandings about organ donation

• Organ donation is a personal decision and the wishes of the family are always respected. 
• Organ donation is only considered after brain-death has been confirmed by several doctors. There are very specific criteria for brain-death to be diagnosed.
• The removal of organs is performed with the same care and precision as any other surgical operation.
• Aside from a surgical wound, the donor's body does not look different after the organs have been removed, and funeral arrangements are not delayed. 

I have always carried an organ donor card in my wallet, not that it would be likely to be seen if I was fatally injured in a car accident. I also had a little red sticker on my licence but it fell off a while back. We have discussed the issue at home several times and my wife and children are aware of my wish to be an organ donor if the situation should arise. They have also expressed the same wish for themselves. Discussion at home before a tragic situation occurs is the best approach. 

Since October 1994 there is now an Organ Donor Registry where people are able to record their wishes. It is hoped that the registry will facilitate transplantation in Victoria and give many people another chance at life. It has the support of the Australian Medical Association (Vic) and service clubs like Lions and Rotary. Generous funding and assistance from Glaxo (Australia) and several other sponsors have made the registry possible. 

The purpose of the registry is simply to give people an opportunity to register their wish to become an organ donor. People simply fill in a registration form, have it witnessed by a member of their family, and mail it in. Acknowledgement of the registration is sent back within days. 

In the event of a tragic accident it is easier for the family if it can be explained that the deceased person had registered a wish to be an organ donor. If the family decided against organ donation, that decision would always be respected. The registry will be updated regularly and people can remove their names any time they wish. 

Over the years I have seen the organ donation and transplantation issue from many angles. As a casualty doctor I was involved in the resuscitation of stroke victims and people critically injured in motor vehicle accidents. In intensive care I saw those cases where it became clear that brain death had occurred. I have worked in a renal unit and seen the joy of patients on dialysis when they become free to return to a normal life. And in general practice several of my patients have had kidney transplants and one a heart transplant.

In years to come there will be much discussion about organ donation and the Organ Donor Registry. There has already been considerable interest from other Australian states. Perhaps a national registry will eventually be in place.

Weblink: www.organdonor.com.au

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: December 11, 2004