Mal Washer (Moore, Liberal Party) Share this | Hansard source

The Australian Organ and Tissue Donation and Transplantation Authority Bill 2008 will establish the Australian Organ and Tissue Donation and Transplantation Authority. This authority will oversee the coordinated and integrated national approach towards organ and tissue donation and transplantation. The bill also provides for a legislative framework to implement the measures outlined in the Australian government’s world’s best practice reform package for organ and tissue donation and transplantation announced in July this year.

At any one time in Australia there are around 1,800 people waiting for an organ donation that could save or transform their lives. Last year there were only 657 transplants from 198 deceased donors. Figures from 2006 from the International Registry of Organ Donation and Transplantation indicated that there are only 9.8 donors for every one million persons in Australia. Ironically, 90 per cent of Australians support organ donation. This is in sharp contrast to Spain, which has 33.8 donors for every one million persons—three times more than Australia.

Spain is the world leader in organ donation rates. How has this been achieved? According to Rafael Matesanz, director of that country’s national transplant organisation, this is due to efficient transplantation coordination and the way families are approached—not the policy of assumed consent, as suggested by some. While it can be seen that countries that have presumed consent have between 20 and 25 per cent higher donation rates than those with informed consent, some countries do not follow this trend when it is introduced. Sweden, for example, switched to assumed consent in 1996; it has one of the lowest rates of donation in Europe and changing the law made little difference. It is interesting to note that a European poll showed that, in the UK, 63 per cent said they were in favour of organ and tissue donation; however, 43 per cent of families refused permission for their relative’s organs to be removed. However, when families of Britons who die in Spain are approached in Spanish hospitals, the refusal rate falls to nine per cent. In fact, Spain had low rates of donation until a national network was set up in 1992—13 years after presumed consent was introduced.

Evidence from the US also indicates the importance of approaching families in the right way. A survey done by the Beth Israel Deaconess Medical Centre in Boston of 74 parents who had been asked to donate the organs of their recently deceased children showed that they were more likely to agree if they had been given information before the death, if the mention of donation came from the child’s doctor and if they had some time to think about the decision. Spain understands this. Their central agency drives and coordinates a nationally consistent approach to clinical systems and practices, and to community awareness and professional education. Hospitals and their staff have sufficient training and capacity to identify all potential donors, and there are no cost barriers in hospitals that prevent organ donation proceeding.

This bill implements a reform package that has learnt from this international and national experience and is based on Australian context and expertise. The new independent authority will provide national leadership to the organ and tissue sector and will drive, implement and monitor national reform initiatives and programs. They will: oversee and support a national network of clinical specialists in hospitals who are dedicated to organ donation; oversee a national network of organ procurement organisations which will manage the procurement process according to national protocols and systems; manage and monitor an ongoing community awareness and education program; introduce and manage a world-class national data and reporting system; administer funds to non-government organisations and provide essential associated services such as clinical data analysis and reporting, national organ matching services and professional training and education for clinical staff; and work closely with national clinical organisations in the development of consistent clinical practice protocols covering the donation process, allocation and waiting list management.

The bill will also provide new funding for medical specialist positions and other clinical positions in public and private hospitals dedicated to organ and tissue donation; provide a funding stream for public and private hospitals to cover the additional staff and infrastructure costs associated; implement an enhanced national education and training program for health professionals involved with organ donation; implement an ongoing community awareness and education program to increase knowledge about donation and transplantation and build confidence in Australia’s donation for transplantation system; provide appropriate support for the families of the deceased donors; implement equitable, safe and transparent national processes to manage waiting lists and the allocation of donated organs; and provide other national initiatives, including living donation programs such as paired kidney exchange. The funding of the overall package will be $151.1 million, including $136.4 million in new funding.

Our medical science in relation to successful organ transplantation is improving all the time. Research conducted at the Massachusetts General Hospital in Boston has seen four out of five patients who were given non-matching kidneys successfully adopt their new organ and live without immunosuppressant drugs for up to 4½ years. This was done by using bone marrow from the donor. Firstly, the recipient’s bone marrow was partially destroyed and an antibody used to lower the level of T cells—the immune cells responsible for organ rejection. Then they transplanted the kidney along with bone marrow derived cells from the donor and kept the patient in a sterile environment for about two weeks. The donated cells and the patient’s own cells created a mixed bone marrow, which caused the immune system to accept both the patient’s cells and the donated organ. Even though the chimeric state is temporary, the tolerance seems to be long-lasting, and work with animals suggests that it may last indefinitely.

The 1,800 people waiting for transplants represent significant costs. For every person waiting for a kidney, the cost is around $83,000 per annum if they are on hospital based dialysis. In contrast, the cost of a kidney transplant is just $65,000 per recipient that year and around $11,000 for every year thereafter. More importantly, the human cost is very high. For some it is the ability to have a normal life and for others it is the difference between life and death. In a country such as ours, with our medical knowledge and technology, it is very sad that, although we have seen an increase of one million in the number of organ donor registrations since 2002 to six million, there has been no increase in the number of lives being saved through transplants. This bill intends to change that, and I highly commend it to the House.

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