Organ Donation In Australia: The Facts

Yesterday, we ran a US-sourced story on organ donation that caused something of an uproar. Here's the accurate picture for Australian organ donors, along with our apology. Before I do start though, I've got to apologise. Partly because I know that there are some folk who will flick into this article, see the length and immediately scroll to the bottom to register outrage anyway. To a certain extent, we've earned that, but at least if I register my apology now, there's a fair chance you'll read it. That aside, the story we ran yesterday was a mistake, and I regret running it; in the midst of a busy day I took my eye off the ball and it was cleared to run; as I wear the editor's hat, I wear the editor's responsibility. I'm sorry.

So what is the Australian picture, anyway? Within Australia there's a lot of publicity surrounding organ donation, but nowhere near enough donors. The Organ and Tissue Authority stated that 337 Australians who died last year donated their organs. That's a 9 per cent increase over the year before, which is encouraging, as are the 1,001 people who were able to receive an organ donation, but as a nation we're still trailing organ donation rates worldwide. For a nation as competitive as Australia, we can (and should) do better.

Given that a single donor can affect the lives of dozens of people, and the waiting lists for certain organ types can stretch into years — years that those on the donor waiting lists often don't have — it's a highly worthwhile decision, but one that it's vital for you to discuss with your relatives, as once you've been declared eligible to be a donor, your relatives will be consulted to ensure that you hadn't changed your mind in the meantime.

I personally can't imagine a situation in which my relatives wouldn't uphold my wishes — I'm perfectly OK with my organs being used to change and save lives once I'm no longer using them — but it is a touchy and emotional subject that you'd be much better off clearing beforehand. Today might be a good day. It's possible to state your organ donation wishes on your drivers' licence registration forms, but that's a state based register; the Australian government also runs the national Australian Organ Donor Register as well as the DonateLife web site which also provides a way to access the register. DonateLife also allows you to record a message to your relatives to make your donation wishes crystal clear. There are no age limitations on organ donation, although those under the age of 16 can't register on the organ donor list; they can however discuss their wishes with their parents or legal guardians.

Organ donation doesn't change the appearance of the donor post-death, so it's entirely possible to have an open casket funeral if that's your wish; equally there are relatively few religions with opposition to organ donation; the DonateLife site has an excellent page discussing that issue here.

It's also worth noting that organ donation and leaving your organs (or other parts of your body) for medical research are two completely different things; if you opt for organ donation you won't end up as a research subject without your express additional permission in Australia.

What then of the issue of brain death, which the original article very clumsily approached? I've taken the definition of what happens in Australia from the New South Wales Department Of Health web site, which (with emphasis bolded by me) writes that

Under Australian law there are two definitions for death: cardiac death and brain death. Cardiac death occurs when a person is not breathing and their heart stops and cannot be restarted. As a consequence of this the brain will then stop functioning as it is being starved of oxygen. Brain Death occurs as a result of the same things except they occur in a different order. The brain sustains a severe injury, is starved of oxygen and stops functioning. As the brain stops functioning vital centres become affected, the person stops breathing on their own and eventually the heart stops.

There is a checklist of things that must be covered before brain death tests can begin. The checklist rules out whether or not there are other causes of the coma. Two appropriately qualified senior doctors perform separate tests at the bedside to determine whether the brain is working or not. These doctors check to see if the cranial nerves that pass through the brain stem and control all vital involuntary reflexes are working. They will be looking to see if the person has any: response to pain; response to light by the pupil of each eye; blinking response when each eye is touched; eye movement or response to ice cold water when it is put into the ear canal,; cough or gag (swallowing) reaction when the back of the throat is touched; breathing when the person is disconnected from the ventilator . For a person to be declared brain dead they must not show any response to each and every one of these tests.

After brain death has been confirmed the Intensive Care doctor will meet with the immediate family to confirm the result of the brain death testing and discuss the implications of this outcome. Patient care will not change until after that meeting has taken place. Options for a family at this time are to stop the ventilation and allow the heart to stop or if the patient wanted to be an organ donor – to keep the patient in Intensive Care connected to the ventilator receiving care for another 10 to 12 hours.

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