Carol Brown (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak tonight on the vital but often delicate issue of organ donation in Australia. The issue is set to attract renewed attention and debate in the coming months, beginning with Australian Organ Donation Awareness Week, running from next Monday, 17 February to Monday, 24 February. This includes a national media campaign to raise community awareness about the urgent need for organ and tissue donation in Australia.

Following the National Organ Donation Awareness Week, the Tasmanian Legislative Council Select Committee on Organ Donation is due to table its report in March. I understand that the National Clinical Taskforce on Organ and Tissue Donation, established by the former Minister for Health and Ageing in 2006, is also set to hand down its report, including its views on the principles for reform of the national organisational infrastructure for organ donation. All this momentum on the issue of organ donation nationally and in my home state of Tasmania in the coming months promises to stimulate renewed debate regarding the best way of improving organ donation rates and ultimately access to organ transplants in Australia.

As most of you are probably already aware, Australia has one of the highest success rates for organ transplants in the world, with on average 90 per cent of patients still alive a year after their operation. The success rate for kidney transplant recipients is even higher, with an average of 96.5 per cent of kidney transplant recipients alive one year on. These figures undoubtedly prove that the choice to donate one’s organs in Australia can and does in fact result in real outcomes in the saving of lives. They also provide a source of hope for all those Australians and their families who are in need of an organ transplant. Indeed, it is estimated that one organ donor can potentially save up to as many as 10 Australians in need of transplants. The precious value of the decision to donate is proven by the fact that last year alone, while only 198 Australian were able to successfully donate their organs, roughly 626 were able to receive an organ transplant.

Unfortunately, these overwhelmingly positive figures regarding the success rate of organ transplants in Australia are not matched by overwhelmingly positive figures regarding the rate of organ donation. Sadly, while Australia has one of the highest success rates for organ transplants in the world, it also has one of the lowest rates of organ donation. In real terms this means that, while a patient’s chances of survival after an organ transplant are very high, their chances of actually securing an organ suitable for transplant are much lower. For the majority of Australians waiting for an organ transplant their biggest battle is in fact in waiting for and finding a suitable donor. Currently there are approximately 1,800 Australians suffering from life-threatening illnesses awaiting an organ transplant. It is estimated that 100 of these people will die before they are actually able to receive an organ donation.

With over 90 per cent of people in Australia indicating that they support the concept of organ donation, the tragic and possibly avoidable loss of these lives just does not make sense to me. In light of the success rates of organ transplants and the widespread public support for organ donation, something needs to be done to improve the rate of donation in Australia. This is simply the only difference between those 100 extra lives being saved or lost. However, while in theory the solution may seem relatively simple, in practice there are various factors that need to be clearly considered.

As I acknowledged earlier, while improving organ donation rates in Australia needs to be, I believe, a national priority, the issue itself is a sensitive and delicate one. The issue of organ donation is an intrinsically difficult one, as to save one life another must first be lost. Therefore, under the current system, a person electing to donate their organs is by nature first forced to face their own mortality to a degree, which for some can be quite challenging and confronting. Likewise, there is the task of communicating such wishes to loved ones, who often have difficulty conceiving the stark reality of such a decision. Further, for such families, if they are ever faced with the reality of such a decision, it could not come at a more emotionally challenging time. On the other hand, patients awaiting a transplant and their families are forced with the difficulty of balancing their desire to receive an organ with the reality that this must first result in the loss of another life.

The reality is that for many the decision to donate their organs ends up being an emotionally charged one as, inevitably, it is associated with death. However, as anyone who has had the pleasure, as I have had, of meeting either a transplant recipient or a patient awaiting a transplant would know, their concept of the decision to donate is quite a different one—it is one of overwhelming life. For these people, the selfless decision by another to donate their organs quite simply converts for them into a second chance at life. These people have often been forced to endure the challenge of living with a life-threatening illness for a significant period of time and the receipt of a suitable organ often signifies the end of their pain and anguish and a chance to start afresh.

During the course of the inquiry by the Senate Standing Committee on Community Affairs into the patient travel assistance scheme last year I met a number of people on dialysis awaiting kidney transplants and their courage was commendable. The majority, because of their age, were faced with the prospect of dialysing three times a week for the remainder of their lives and never receiving a transplant. Despite this, I had one particular gentleman tell me that he himself planned, if he was able, to donate the rest of his organs, although he doubted his kidneys would be much use to anyone. For me, this comment epitomised what it means to be a donor—it is all about giving.

In a recent paper, Andrew Lawrence rightly points out that, ‘Organ transplants extend life, enhance the quality of life and reduce health costs.’ Speak to any successful transplant recipient and they will confirm the validity of the first two points. And compare, as Lawrence does, the cost of maintaining a patient on dialysis with the immediate cost of an organ transplant, and the third point is also true. Lawrence estimates that haemodialysis for one patient costs around $50,000 a year, whereas the cost of a kidney transplant is under $15,000 and only an extra $15,000 to $20,000 is required for ongoing treatment for transplant patients. Further this means in real terms that if 1,500 patients awaiting a kidney transplant received successful transplants, at least $22.7 million, on the above estimates, would be freed up in the health system in the first year to be spent elsewhere. Therefore, while not only being the best available treatment for patients suffering from, in this case, kidney failure, organ transplantation also results in a reduction in the costs associated with that patient care. Yet, as I noted earlier, despite all this—despite 90 per cent of Australians supporting organ donation, despite there being more patients waiting for organs than there are donors, despite transplantation being cheaper and the best available option for the treatment of a patient suffering from organ failure—Australia still has one of the lowest organ donation rates in the world.

As I pointed out earlier, there are currently two separate reports due to be handed down in the next couple of months at both state and federal level which will examine ways in which the rate of organ donation in this country could be improved. I personally would support any initiative which results in a real increase in the number of organ donors in Australia, and I believe that all appropriate options should and need to be considered. However, not wanting to pre-empt any findings or outcomes likely to come out of the two separate reports, experience here and overseas highlights several factors which play a pivotal role in lifting rates of donation, including the quality of the health system and services available and the actual programs used at the coalface in hospitals to identify potential donors.

Obviously the continued success rates of organ transplantation in Australia will depend on the health system’s capacity to cope with an increased number of transplant patients and surgeries in the event of an increase in the rate of donations over the next couple of years. The Rudd Labor government has established a $2 billion national health reform plan, to be implemented over the next four years, to improve Australia’s health system and ensure better health services for patients in hospitals, including reducing waiting times for those requiring essential hospital services such as organ transplants. This reform plan will ensure that hospitals around Australia will, over the next four years, be better equipped to handle any increase in the number of organ transplant surgeries likely to occur as a result of an increase in the number of donations. Likewise, the national health reform plan will facilitate a range of options including the resources available to hospitals when it comes to the implementation of programs aimed at increasing and identifying potential organ donors. Because only one per cent of patients who pass away are suitable candidates for organ donation, effectively coordinated programs in hospitals used to identify potential donors are crucial.

Alan Ferguson (President) Share this | Link to this | Hansard source

Order! Senator Carol Brown, your time has expired.

Carol Brown (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I seek leave to have the remainder of my speech incorporated in Hansard.

Leave granted.

The incorporated speech read as follows—

A 1991 study found that 509 of families of potential donors were never asked about donation because the medical staff on hand did not consider organ donation a possibility.

We have come some way to address this issue, and a 2006 study found that about 209 of potential donors in Victorian hospitals were missed.

Evidence from here and abroad suggests that effective donor identification programs in hospitals can result in considerable increase in organ donations.

After opting to implement some features of the ‘Spanish-based model’ of organ identification program in 1996, South Australia saw a rise in donations from 14 donors per million to 24 donors per million in 1998.

Since then South Australia’s rate of donation has been around 20 donors per million—double the nation’s average of 10 donors per million.

The South Australian model involves medical donor coordinators identifying potential donors in hospitals who, together with the transplant coordinators, discuss with families the deceased wishes about organ donation. This type of support is essential not only to help identify potential donors but also to assist grieving families through what can be a difficult period. I would personally advocate the implementation of a standardised program based on the South Australian model, in ultimately all Australian hospitals. As the South Australian example proves, such a program has the potential to lift organ donation rates in Australia and thus save more Australian lives.

I understand that the Australian Health Ministers’ Council recently agreed to continue funding for the National Organ Donor Collaborative until at least June 2009. The National Organ Donor Collaborative was launched in 2006 and has delivered very promising results.

The Collaborative involves training hospital teams in 26 hospitals throughout Australia in collective learning, enabling best practice to be replicated within their hospital. The Collaborative has been endorsed by health professionals as a major initiative for organ donation. It is seen as a means of developing networks and linkages across states and hospitals; between ICU, emergency and donor agencies; and between organ, eye and tissue donation. It provides an opportunity for diverse health professionals to work together, focused solely on donation.

Over the coming months I very much look forward to the two reports due to be handed down in Tasmania and on a national level which are set to consider these issues in more detail. As I stated earlier I am more than prepared to support any measure that results in the rate of organ donation in Australia increase in the future.

In the meantime I commend all those working in the sector for the tireless work that they put in each year to promote this worthy cause. I would eagerly encourage each of my colleagues to support them in their up and coming National Organ Donation Awareness week campaign—I know that I certainly will be.