Anne Urquhart (Tasmania, Australian Labor Party) Share this | Link to this | Hansard source

I rise to speak on a very important health topic in this country: organ and tissue donation. Despite widespread public support for the concept of organ and tissue donation and Australia being recognised as a world leader in transplantation medicine, Australia has very low donation rates by world standards. It is vital that everyone knows the wishes of their family. Even if someone is registered as a donor, the family must still provide consent. This is more likely when the family is aware of and understands the wishes of their loved one. All Australians need to discuss their organ donation preferences with their family. My family have discussed this on a number of occasions and have ensured that we are all fully aware of each of our wishes.

Death is not an easy subject but, as organ and tissue donation has the potential to save many lives, it is a very important discussion. It may have been a bit easier for my family as a close relative works as a nurse in an accident and emergency section of a busy hospital. She sees families lose loved ones through sickness or an accident, an extremely traumatic time. My relative has recounted to the family how difficult it is for the hospital staff to approach the family and ask questions about organ donation, and this difficulty only increases if the deceased was not registered or the family had not considered it before. It is remarkable how much easier it is when the family knows their loved one's wishes. Although it is still difficult, if the deceased has declared their wishes and discussed them with their family, that burden on the family at such a grief stricken time is far less.

Last year, the average Australian donor rate was 13.8 per million people, and the top state was my home state of Tasmania with 19.7 donors per million people. While this is a great honour for Tasmania to hold, that actually equates to 10 organ donors from Tasmania in 2010, which some may laugh off as an inconsequential number. However, it is interesting and important to understand that one person can donate multiple organs, so the 10 Tasmanians potentially benefited more than 40 or 50 people across the country. It is a great effort compared to Tasmania's previous donation rates and I congratulate the Tasmanian DonateLife team, all medical staff involved and the families of donors for their work increasing this rate.

Organ donation involves the transplantation of organs from one person to another when a person is facing the possibility of organ failure, leading to debility or death. Whole organs such as the heart, lungs, liver, pancreas and kidneys can be donated, as well as sections of tissue such as heart valves, corneas, tendons and skin. Organs and tissue are usually removed from people who have recently died. However, kidneys and parts of the liver and pancreas may also be removed from living donors. It is important to note that organ donation from a deceased person can only be carried out under quite specific circumstances, with organ donation possible in less than two per cent of deaths. Typically, a potential donor is pronounced as brain dead while in the intensive care unit of a hospital and put on a ventilator that keeps their organs functioning artificially for a limited time. The ventilator keeps blood and oxygen pumping around the body artificially to keep the organs functioning. The skin continues to be pink and warm even though the person is dead.

Before organ donation after death can begin, two senior doctors must separately test the person for brain death. Brain death occurs when the brain is so badly damaged that it stops functioning permanently. When the brain dies, circulation ceases and all other organs stop functioning. Clinical tests indicate brain death has occurred when there is no brain function, no blood flow to the brain and no possibility that the brain will recover and function again. Brain death is not the same as a coma, where the brain still functions. Most people die a cardiac death, where they stop breathing and have no heartbeat. On death, the blood stops carrying oxygen through the body. The person feels cold to the touch and changes colour as the organs, including the brain, are starved of blood and oxygen. Organs can be removed following cardiac death in very specific circumstances.

Australia had a record year for organ donation in 2010, with 309 multi-organ donors saving or improving the lives of 931 people. There were also many thousands of tissue transplants over this period. The latest performance report from the Australian Organ and Tissue Donation and Transplantation Authority for September 2011 shows that we are on course to break that figure again. The forecast is for about 330 organ donors in 2011, over 100 more than in 2008.

Unfortunately, over 1,500 people across Australia are waiting on the list for organ donation. Some wait only a few months; others may wait for years. Tragically, many people die while waiting. For many others, the wait means long weeks or months in hospital or several trips to hospital every week for treatment such as dialysis. It is my hope that, through continuing to air the positives of organ donation, more Australians will see that only good can come from being an organ and tissue donor, only good can come from discussing organ donation with your family and only good can come from your loved ones being organ and tissue donors.

While the majority of organ donation is only possible if the donor is deceased, there are a number of cases where organs, mostly kidneys, are donated by a living donor. One of my close relatives has the disease lupus, which is attacking his kidneys. He has been preparing to undertake dialysis at home, with a stent inserted in his stomach in preparation for dialysis in case of renal failure. However, continued infections have required the removal of this stent. The last option, other than dialysis through regular hospitalisation, is kidney transplantation. When he learnt that his kidneys were failing and he would eventually need some drastic intervention, there were offers from wide and far.

We often hear of this happening when people in the public spotlight have a similar illness, but we do not stop and think about the large number of very generous people who offer part of their body to their relative or their mate. Those who volunteer to be a donor undertake a very long process, involving dozens of tests, to gauge whether their kidneys are healthy and suitable for donation as well as whether they are compatible. There are many discussions with counsellors to build the emotional strength to deal with this huge decision and to ensure that both the donor and the recipient are aware of the consequences of their decision and of the physical stress the donor will be under for a period after donation.

While going through all of these steps, donors and recipients are advised of another process called pairing, where a search is undertaken to find better matches for donor-recipient pairs. This search process is done through the Australian Paired Kidney Exchange program, which seeks to increase the number of live kidney donor transplants. This program seeks to achieve the best outcome for all involved, as pairing significantly increases the chances of the kidney surviving the transplantation. The paired kidney exchange occurs at two different transplant centres at the same time. Each donor-recipient pair remains at their own transplant centre. In this way, each donor is sure that the other has gone through with the surgery. Each kidney is then transported to the corresponding transplant centre and the patient receives their new kidney on the same day their friend or relative has donated.

Most organ donors do not get the opportunity to undertake these procedures, as their organs are donated at a time when death has occurred. But, to the recipient and their family, there is no greater gift than that of an organ to provide their loved one with a better quality of life or indeed life itself. That is why we need to lift our current consent rate of 60 per cent, which is lagging at that level because many families do not feel they can confidently make a decision about the wishes of the deceased. Many people have not discussed their donation decision with family members in the past 12 months. Many cannot remember, particularly at a time when they are grief-stricken.

Australians need to ask themselves and their families the simple but challenging questions. You can get engaged with the facts by downloading the family discussion kit at www.donatelife.gov.au and asking yourself—and discussing with your family—the following questions: do you want to be an organ donor; have you registered; have you discussed your decision with your family; and do you know if your relatives are willing to be organ donors? That last one is, perhaps, the more important question.