From:The Australian
"Have the conversation over dinner about being an organ donor and talk to your family about it," she urged. "Gifting organs saves lives and allows people to go on and do remarkable things."
Her call has been welcomed by everyone in the transplant community, as it is seen as a push towards improving Australia's comparatively low rate of organ transplants.
But critics of the national transplant program - the Australian Organ and Tissue Authority, established in January 2009 - argue AOTA is not maximising such community goodwill.
For starters, transplant physician Bruce Pussell says a $5 million AOTA publicity campaign last year - which was followed up in June - is a waste of money, because it focused on encouraging people to register as donors. "There's no correlation between the number of people registered as donors and the donor [transplant] rate," says Pussell, professor of medicine with the University of NSW. According to him, what matters is the number of deceased donor organ transplants conducted. Doctoral student Aric Bendorf agrees, adding that Australian rates are below international standards.
"Australia's deceased organ donation rate continues to languish in the bottom third of Organisation for Economic Co-operation and Development national rankings," says Bendorf , who is with the University of Sydney's Centre for Values, Ethics and the Law in Medicine.
His assessment - based on 20 years of comparative data - sits neatly with statistics released this week by the independent medical reform group ShareLife. According to its 10th Transplantation Scorecard, Australia continues to lag behind other developed nations, despite setting up AOTA, with funding to the tune of $151m over four years. Using AOTA statistics, ShareLife finds the national rate of about 43 transplants per million (tpm) a year is far from the target of 80-90tpm achieved by industrialised countries such as Spain, the world leader in organ transplants. And although AOTA disagrees with ShareLife's methodology, it's estimate of 45.3tpm is still far from best practice.
"No one disputes there's need for reform in Australia and we're working hard to increase our deceased organ donation and transplantation rate," says AOTA chief executive Yael Cass, appointed last February. She claims transplants increased 10 per cent in the year to June. She also argues that it took Spain 10 years to reach its present rate, so it's unreasonable to expect Australia to match its success so soon.
That claim is hotly disputed by Pussell, a ShareLife director: "Portugal and Croatia [report] they've improved to world's best practice within three years of adopting the Spanish model."
The so-called Spanish model is at the heart of the intellectual fisticuffs. The country was the first to seriously rethink how it handled identification of potential donors, obtaining consent of familes and getting donated organs to the right recipient efficiently and humanely. The system is the gold standard.
According to ShareLlife chairman Marvin Weinman, the model accepted and funded by the Rudd government in 2008 was based on the "elements and mechanics" of successful systems such as that of Spain.
"The idea was not to do what we did better, but to do what works, what leaders internationally have accomplished," he says.
Cass and AOTA's newly appointed national medical director, pediatric intensive care specialist Jonathan Gillis, vehemently dispute many of ShareLife's specific criticisms about issues such as the appointment, training, role and communication lines of in-hospital donor co-ordinators - identified by Bendorf as among the most critical roles in successful national programs.
Pussell says they should be full-time, specifically trained staff with clear lines of communication. Gillis defends the practice of largely part-time positions, filled by intensive care or emergency department specialists.
Still, even ShareLife acknowledges AOTA is making progress. As Pussell says: "They've instituted a set of national clinical triggers [to identify potential donors].
"They've put people in the hospitals, including the nurses, and some education is going on in the hospital," he notes.
"The question is: how adequate is this and how is it being evaluated?" Time will tell, he says. Time will tell.
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