Many opportunities for organ donation are being missed in Australian hospitals, contributing to organ donation rates that are among the lowest in the Western world, according to research published in the latest edition of the Medical Journal of Australia (MJA).
Dr Helen Opdam and Dr William Silvester, Intensive Care Specialists at Austin Health, Melbourne, studied deaths in Victorian hospitals to identify potential organ donors who did not go on to donate organs, and the reasons this occurred.
According to Dr Opdam, medical consultant to the Victorian Organ Donation Service, the organ donation rate in 2004 was 11 organ donors per million population for Australia as a whole and 9 per million for Victoria.
This compares with rates of 35 per million in Spain, 24 per million in the United States, and 20-23 per million in much of Western Europe.
"Many of the 1,663 people on the transplant waiting list [in Australia] will have died awaiting a transplant", says Dr Opdam.
Dr Opdam and Dr Silvester analysed all deaths between 2002 and 2004 in 12 major Victorian hospitals. Among 17,000 deaths, they identified 280 potential organ donors. In 60 cases, organ donation was not requested from relatives.
When organ donation was discussed with next-of-kin, the consent rate was around 50 per cent.
The figure is lower than was anticipated from surveys of public donor intention and is at odds with community support for transplantation, when the health outcomes for transplant recipients in Australian are equal to or surpass those internationally.
The authors said there is real potential to increase the number of organ donors in Victoria through increasing the rates of identification of potential donors and requests for organ donation as well as consent rates.
Dr Opdam says it is important that organ donation is raised with next-of-kin in all appropriate circumstances and that families are supported in their decision-making. All Australians should ensure that their next-of-kin know their wishes regarding organ donation, she says.
Dr Opdam calculates the maximum rate of organ donation in Victoria could be 15 to 17 donors per million, a number sufficient to satisfy the current demand for organ transplants.
In an editorial in the same issue, Associate Professor Timothy Mathew, Medical Director of Kidney Health Australia, and Dr Jeremy Chapman, Director of Acute Interventional Medicine, Westmead Hospital, Sydney, describe a 20 per cent increase in organ donation rates in the United States after the introduction of a national program of collaboration between hospitals to share successful strategies.
A similar program has now been funded in Australia, for which they say they have high hopes.