Steve Georganas (Hindmarsh, Australian Labor Party) Share this | Hansard source

I too rise to speak in support of the Australian Organ and Tissue Donation and Transplantation Authority Bill 2008. The feature of the bill is of course the creation of the authority by January 2009, with the purpose of establishing a coordinated, consistent national approach to organ donation, including a network of organ and tissue donation agencies. The new authority will work within the context of the Rudd Labor government’s national reform package, which was announced on 2 July this year and endorsed by the Council of Australian Governments one day later. The national reform package will consist of targeted efforts to improve critical areas of the organ donation and transplantation sector.

I will run through a few ofthe key areas. Funding of $151.1 million over four years will see the reform package deliver the following: dedicated organ donation specialist doctors and other staff in public and private hospitals; new funding for hospitals to meet the additional staffing, bed and infrastructure costs associated with organ donation; continued national public awareness and education, which is very important; support for families of deceased donors; and other significant measures, including enhanced professional education programs, consistent clinical protocols, clinical trigger checklists to help hospital staff to appropriately identify potential donors, and data collection for organ transplants in hospitals.

Naturally, the focus of the government’s efforts is to increase the incidence of organ donation within Australia, which will sustain life of the best possible quality that our nation’s medical expertise can support. Figures already cited in this debate are worth keeping in mind. In 2007, the passing of 198 organ donors resulted in 657 organ transplants. That is potentially three lives saved for the action of each and every organ donor. That is remarkable—the thought that each and every donor could potentially make such a difference to multiple recipients of organ donations, not to mention the family members and loved ones of each of those organ recipients who would have had their most earnest prayers answered through such surgery.

However great the contribution of any organ donor is, only a third of those in need of a transplant in 2007 were fortunate enough to be blessed with the needed gift. More than 1,800 Australians are on the organ donor waiting list at any one time, and demand for transplants is likely to grow in the future with our ageing population. An increase in the ageing population will have an impact on lifestyles and there will be more need for organ transplants. We need to do all we can to support the increased prevalence of organ donors and the deployment of their organs once the donor’s time has come.

Different methods have been trialled around the world to increase the proportion of the population that subscribes to organ donation. Organisational incentives—that is, incentives to donate organs through a form of loyalty points scheme of donors and organ recipients—are practised to an extent in certain communities within the United States. Their preferred allocation system gives members of the community of organ donors slightly higher chances of receiving an organ donation should the need arise. This is a form of closed-community benefit whereby the members of the donor community have some limited form of reciprocal rights to acquire the available organs by virtue of their pledge to be an organ donor. I am not suggesting we go down that path—far from it. But I do believe there are practical contributions that a government can make, contributions that have been successfully demonstrated in countries around the world. In pursuing world’s best practice, this government is clearly doing the best anybody can.

On the point of the government’s package aiding and supporting the medical and medical support workforce in their duties, I would like to mention a study that sought to explain a 16-fold increase in organ donations over a few years within Puerto Rico. I acknowledge that Australia is very different from Puerto Rico. But it was interesting to note how crucial the focus of authorities was on supporting and assisting the medical workforce and others to develop the systems required to make organ donation work—and work well it does. Not only are medical professionals central to the success of such work but all the support and ancillary staff within the hospitals, and in the community, are involved in creating public awareness and acceptance. The extensive work on the service delivery and logistical side of the equation was fundamental to the successful increase in organ donations within that territory.

I congratulate the government for supporting these crucial factors, but it is not necessarily just a matter of getting the skills, resources, systems and logistics to a superior level. Medical professionals can need other forms of support as well. One factor that has limited the success of organ donor registration programs overseas is the communication of the legitimate feelings and wishes of the surviving family members.

Within Canada, a recent study highlighted how crucial medical staff are in working with the deceased person’s next of kin. A 2006 Canadian study found that, while family vetos had no standing in law, over two-thirds of the medical community surveyed believed that the family members of a deceased person should be able to veto the deceased family member’s determination to donate organs. That is two out of three medical staff being open to discounting a deceased organ donor’s wishes. As it happens, the same study found that only about one-third of the public thought the family should be able to veto the donor’s wishes. But there was clear evidence of the medical community exercising their authority in preference for the wishes of the surviving family members as opposed to the wishes of the deceased. Thankfully, the study reported that, in the majority of cases, the family did comply with the wishes of the deceased and approved organ transplantation.

Whether the medical community’s preference for the surviving family members’ wishes was due to legal confusion, fear of retaliation by the surviving family or out of compassion for those who were left behind, it is difficult to say. But, clearly, there is potential for emotional considerations felt at that point in the hospital setting to become central to the issue of organ availability and the saving of lives, and it may well need to be addressed calmly, rationally and with support offered to all concerned.

The influence of surviving family members on whether or not a donor’s wishes are actioned is not limited to Canada. Within the United States, researchers similarly point to surviving relatives vetoing the donor’s previously expressed wishes upon the donor’s passing. Whatever the donor had arranged prior to his or her death, whatever his or her beliefs and intentions, the will of the family often determines organ availability. And so I am especially supportive of the reform package assisting professional medical staff in this particular area of working with the surviving family members in recognition of the donor’s expressed wishes. This is not an easy task. It is likely to be an emotional and even ethical battle fought by many of those touched by such circumstances.

I have read that, while no major world religion—that I know of—uniformly forbids organ transplantation and many actively support it, there is clearly resistance to it within some denominations and religious communities. An online journal article I was reading asserted that some Orthodox Jews and Buddhists oppose transplantation because of issues surrounding brain death criteria—that is, the point at which a person is said to be technically dead. And this may be the case with others, those who are suspicious of who may be benefiting from a person being pronounced dead.

What is essential? It is essential that people be very well informed of such matters in those situations. Another grouping, Confucians, sometimes oppose transplantation because it violates their notion of bodily integrity, and many Christian Scientists reject the enterprise of transplantation altogether. In Mexico, the bodily integrity issue is to an extent shared by some of Mexico’s millions of Catholics with regard to things post mortem. Matters of faith and belief will always be with us, for good reason.

Perhaps the broader issues relate to the grieving family’s concern over the memory of their lost one. The mere idea of a person’s remains being ‘defiled’ through very substantial surgery can give cause for second thoughts. This is where support from a steady hand within the hospital context can be so very important at that crucial point in time, with people specifically trained and resourced to assist family members so they can work through their concerns for their loved one’s remains, work through any issues they may have with organs living on after their loved one has passed away and, ultimately, resolve to honour what in effect may be one of the last wishes of a person who clearly wanted to do the single best possible deed in support of those in need of life-saving organ transplantation. I support this bill and commend it to the House.

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