Why does Western Australia lag behind in organ donation?
By Jade MacMillan

Linda Franklin has spent two years waiting for the phone call that could change her life.

The Perth mother of two has a chronic lung condition and is one of about 1,700 people Australia-wide in need of an organ transplant.

"I was born premature and as a result of that I've got a condition called Bronchopulmonary dysplasia," she said.

"During my second pregnancy three and a half years ago I became sick and developed pulmonary hypertension.

"As a result I need a double lung transplant and have been on oxygen 24 hours a day ever since."

New figures released by the Australian Organ and Tissue Authority show the number of organ donations and transplants jumped by 19 per cent in the first five months of this year.

The figure is the highest rate recorded for the same period since national records began.

The Authority's National Medical Director Gerry O'Callaghan says the increase is a reflection of a positive trend.

"Since the beginning of the year, organs from 141 donors have saved or improved 416 lives nation-wide," Dr O'Callaghan said.

"We think this is due, in part, to a significant government investment in the capacity and the resources in the health system right across the country in the last three years."

But while donation rates may be increasing nationally, Western Australia is lagging behind.

In 2009, WA recorded the country's lowest donation rate of nine donors per million of the population.

South Australia recorded the highest with 20 donors per million.

Simone McMahon from the Organ Donation and Transplant Foundation of WA says the state faces a unique set of challenges.

"Obviously the size of our state does impact organ donation," she said.

"For example people who tragically die on our country roads, often there's not enough time to transport them to a major hospital within the metropolitan area where organ donation is possible."

"WA isn't in mark with the national increase and I think there is still a lot more work to do from a state perspective."

Solution

A strategy often touted as a solution to low donation rates is an opt-out system of consent, whereby the onus is on people who do not want to to donate to register their wish.

A discussion paper commissioned by the Health Department and tabled in State Parliament last month, recommends the adoption of a system similar to that introduced in Belgium in the 1980's.

The paper was written by the head of Liver and Kidney Surgical Transplant at Sir Charles Gairdner Hospital, Luc Delriviere, and the manager of DonateLife WA, Hal Boronovskis.

While the authors acknowledge the Organ and Tissue Authority has made positive progress in lifting national donation rates, they say more needs to be done.

"The flaw of the current system is despite 77% of the population willing to be an organ or tissue donor, only 39.28% of the eligible population has registered," the paper reads.

"It is essential on this matter to understand that people opposing organ donation are a small but very vocal group. Their ability to steal the debate from a law that would suit the majority of the population has to be perceived and made relative."

The paper points to Belgium as a success story, arguing that within three years of the opt-out system being adopted there, donation rates rose from 11 people per million to 22.

It says while local mortality rates mean donations are unlikely to ever be as high, the model would make a significant difference.

But not everyone is convinced.

"There isn't any evidence that the opt-out legislative structure per se creates an increase in organ and tissue donation," said Dr O'Callaghan.

"Families will always have the final say and so we don't believe that changing the legislation in itself will change the hospital culture and change the access to transplantation in Australia."

Simone McMahon agrees the introduction of an opt-out policy alone is unlikely to give rates the dramatic boost needed.

"The opt-out system from a legislative perspective may well be a good thing, there's still some debate on that as to whether it will be or not," she said.

"But at the end of the day our donation rate will not change if we still have 40 per cent of Australians who don't know their loved ones' wishes."

For people like Linda Franklin, the message is simple: Make sure your wishes are known.

She voluntarily took herself off the donation waiting list after her condition stabilised earlier this year but still hopes to one day receive a transplant.

"At the moment there are others who require lung transplants who are sicker than me," she said.

"I'm still on oxygen 24/7 and a transplant would mean having a normal life, being able to go to the park with my kids and run around, swim in the ocean, travel.

"Talk about the issue with your families. That way even if you're not registered, your family will know your wishes.

"People just don't talk about it.