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Donor numbers are up – but waitlists still exist


Doug Hendrie


29/07/2020 1:27:59 PM

More donors and better techniques have helped, but people are still dying as they wait for an organ transplant.

Operating theatre
Almost twice as many people in Australia now receive organ and tissue transplants compared to 10 years ago.

First, the good news.
 
Almost twice as many people in Australia now receive organ and tissue transplants compared to 10 years ago.
 
And techniques such as split-liver transplants – where a donor liver is divvied up for an adult and child recipient – have seen the mortality rate for children waiting for a liver drop to almost zero.
 
But there is still a real need for more organ and tissue donors, according to Dr Helen Opdam, National Medical Director of the Organ and Tissue Authority.
 
‘There are still people who die for want of an organ transplant, even though donations and transplant rates have increased over the last decade,’ she told newsGP.
 
Recent government efforts to optimise donation processes and boost awareness have doubled the number of donors each year, Dr Opdam said. Last year, 548 people donated their organs after death, with 1444 Australians receiving transplants.
 
GPs, too, have been playing a key role in normalising discussions around donation.
 
But with around 1600 people still on the transplant waitlist, and another 12,000 on dialysis, more must be done.
 
‘If we could further increase the community’s preparedness to donate, that would mean many more life-saving transplants,’ Dr Opdam said.
 
‘Organ transplants are such an amazing treatment. There are not many other things you can do when someone reaches the point of organ failure, but a transplant can be such a dramatic and effective treatment.
 
‘If you talk to someone facing death who receives a transplant, it really is a second chance at life. It is extraordinary.’
 
But lower levels of consent coupled with the surprisingly uncommon circumstances permitting donation means the agonising waitlist still exists.
 
‘What often surprises people is that the opportunity to donate is actually quite rare,’ Dr Opdam said.
 
‘Only around 1300 Australians die each year in circumstances where it’s possible to donate organs.’
 
Organ donors have to pass away while on a ventilator in hospital and leave their organs in a good state for transplant. Those requirements restrict the pool to only around 2% of all those who die in hospital. Family consent is given in around 60% of these scarce cases. 
 
Tissue and eye donors are less restricted, leading to around 12,000 donations annually.
 
‘If people are registered on the donor registry, nine out of 10 go on to donate,’ Dr Opdam said.
 
‘If they’re not registered and their family don’t know what their wishes were about donation, our consent rate is much lower at six out of 10.’
 
Around a third of all Australians have chosen to register on the Australian Organ Donor Registry.
 
‘The vast majority of Australians support organ donation, but only around a third are registered. We’d like to see more people register, as we all want access to transplantation,’ Dr Opdam said.
 
‘If you needed a lifesaving transplant – or your child or spouse did – you’d like to think others are making those generous decisions at that time and enable that opportunity for us.
 
‘If we as a community want access to transplants, we need to be prepared to take action as well.’

Organ-Donors-Hero.jpg
It is important to notify families and friends of a person's decision to donate organs because of the formalities associated with the process.

Dr Opdam said a key issue is the fact people usually do not give the issue much thought until something happens.
 
‘You can just be unlucky to end up with organ failure. A viral infection, heart failure, kidney problems that see you end up on dialysis – it can happen to any of us,’ she said.
 
‘And if you develop organ failure, your only chance of long-term survival is a transplant.’
 
Many people may be fearful about what the procedure entails, and some may even fear that consenting to donate means healthcare workers will not try as hard to save their life.
 
Dr Opdam has heard them all.
 
‘As an intensive specialist, my job is to save lives. Our primary goal is to save someone’s life,’ she said. ‘Only when it becomes clear that death is inevitable or has already occurred is donation considered.
 
‘Others get worried that the donation process may be disfiguring. In fact, it’s incredibly respectfully done, with dignity and respect afforded to the dying person when they donate.’

People can also be concerned that a history of alcohol and other drug use, or smoking, will preclude someone from being a donor. Others often cite religious concerns, though major faiths support transplantation. 
 
‘Some dismiss themselves as being donors because they think they may not be suitable; but, in fact, medical contraindications to being a donor are very few,’ Dr Opdam said.
 
‘We’ve had donors over the age of 80 who have led to lifesaving transplants, especially for the liver, which is an amazing organ.’
 
Organs in need include the heart, lungs, liver, kidneys and pancreas, as well as the intestines.
 
Split-liver transplants
One major success story in the organ transplant field has been the emergence of split-liver transplants, where a single liver can be transplanted into both an adult and a child. The adult receives around 75% of the liver, and the child the remaining 25%.
 
After being pioneered in Germany in the late 1980s, the technique is now used in around one in eight transplants in Australia, and has slashed the risk of children dying on the waitlist to almost zero. 
 
Over the past three decades, transplant surgeon Dr Albert Shun of Sydney’s Children’s Hospital at Westmead, has performed around 400 liver transplants for children.
 
‘The liver is a unique organ. It regenerates. It doesn’t age. You can put part of an adult liver in and it will shrink to the right size for the child, and then grow again as the child grows,’ he told newsGP
 
‘The parents tell me that when their child is very sick, they just lie there. But after the transplant, they’re running around and so active they can’t keep up with them. That’s the sort of difference you’re looking at.
 
‘Some now have grown up, got married and had kids themselves.’
 
Split-liver transplants have been transformative for children waiting for a new organ, with the waitlist often long due to a lack of paediatric donors.
 
‘This technique has been very successful in Australia. We are one of the leading nations where children get transplants using split livers,’ Dr Shun said.
 
Almost 60% of child recipients receive a split liver. At times, a parent can donate part of their liver – which can regenerate – to their child, if no other livers are available.
 
Dr Shun said that procedure is more technically difficult, with more risks involved.
 
‘There is the potential for more complication, but we have gradually learned how to use it over 20 years,’ he said.
 
Dr Shun said new advances will soon make it possible to keep a donor liver alive on a machine for longer periods, allowing surgical teams to choose the best time to do the operation. At present, many transplants are done out of hours due to the need to do the operation soon after the organ becomes available.
 
‘People should think seriously about organ donation – it saves lives,’ Dr Shun said. ‘The success of this program depends very much on the support of society.’
 
This week is DonateLife Week, which encourages Australians to register as an organ donor and to tell their family of their decision.
 
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