Next-of-kin consent is the key to increasing organ donations in Australia

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Australia’s processes for identifying potential organ donors in hospitals is working well but next-of-kins are slowing the system, according to research in the Medical Journal of Australia.

In 2008, the Australian Government set up the National Reform Programme (NRP) to establish the “world’s best practice” in organ and tissue donation.

Part of this is the DonateLife Audit, which aims to report on all actual and potential organ donation activity.

Researchers from the Royal Prince Alfred Hospital (RPAH), which contributes data to DonateLife, conducted a six-month audit of all deaths in the hospital to determine whether potential organ donors were being missed by the DonateLife Audit.

“Although the deceased organ donor rate is increasing in Australia, it is substantially lower than the highest performing countries (Spain),” writes Associate Professor Michael O’Leary, an intensive care specialist at RPAH. “For this reason, we believed that more should be done to identify potential organ donors.”

O’Leary and his co-authors collected data on 427 deaths at RPAH over a six-month period in 2012. Of these 22 patients were potential doors but only 12 patients were referred to the DonateLife team for consideration. Of those, three became organ donors.

There remained 10 patients where a clear reason to exclude them from organ donation was not established and these patients’ records were assessed by organ donation specialists.

Of these 10 patients, eight died on the general wards and of these there were three that might have become organ donors but they would have required mechanical ventilation solely for the purpose of facilitating organ donation.

The hospital audit was compared to the DonateLife Audit, which during the study period identified 16 deaths of patients who could potentially have become organ donors. These 16 patients included all 12 patients identified in the study.

Dr O’Leary and his coauthors says the research shows the DonateLife Audit is doing a good job of
identifying potential organ donors.

“It appears that the principal factors affecting the lower organ donation rate in Australia compared with countries such as Spain are the lower rates of brain death and consent,” the researchers write.

“Maximising consent rates is likely to be the single most effective intervention to increase organ donor numbers within existing medical practice in Australia.”

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