Organ Donation –The Gift of Life

Professor Philip O’Connell

1904

1952 Madame Renard Marius Renard

Damaged a single kidney in

a fall

Peter Bent Brigham Hospital 23 Dec 1954

Andrew Ritteris

John Ritteris

99

40

50

60

70

80

90

100

5 6 7 8 9 10 11 12 13 14 15

% s

urvi

val

1970-74 (440)

1975-84 (1266)

1985-89 (1231)

1990-94 (1415)

4.8% per year

5-year censored survival unchanged

Early improvement but long term attrition%

sur

viva

l

T. Mathew et al, 2001ANZDATA

30

40

50

60

70

80

90

100

757677787980818283848586878889909192939495969798

Australia CD1. One year survival 1975-99

patient

graft

Year of transplantation Years after transplantation

OKT3 IL2-RAATG

CSA

MMF

TACCSA-ME

AZA

GCV VGV

9

KI 1.9 Kidney transplant waiting list activity among adult patients

Data source: Global Observatory on Donation and Transplantation (www.transplant-observatory.org), slide courtesy of S White

112,631 organs were transplanted worldwide in 2011 (76,118 kidneys)

2% pancreas4% lung5% heart

21% liver

68% kidney33% of all transplants from living donors

Provided by Sarah White, George Institute

= 10,000 treated cases of kidney failure

76,118 kidney transplants performed in 2011

2.16 million Patients living on dialysis at 31st

December 2011

Data sources: Global Observatory on Donation and Transplantation (www.transplant-observatory.org)ESRD Patients in 2011: A Global Perspective. Fresenius Medical Care. Bad Homburg, Germany.

On a waiting list for kidney transplantation in 2011

Provided by Sarah White

Territory size is distorted in proportion to the number of organ transplants reported for each country in 2010

<66 to <2020 to <40

Transplantation rate (pmp)

40 to <70>70

Global distribution of transplantation activity

2010

Data source: Global Observatory on Donation and Transplantation (www.transplant-observatory.org), slide courtesy of S White

Provided by Sarah White, George Institute

WHO CAN BE AN ORGAN DONOR?

Potential solid organ donors

How to maximise every opportunity?

Donor procedure• Needs to be done by an

experienced team• On call at short notice

Donor procedure• Minimal ischaemic time. Urgent isolation procedure.

What can people donate?

ORGANS TISSUEKIDNEYS CORNEAS

LIVER HEART VALVESHEART PANCREAS ISLETSLUNGS SKINPANCREAS BONE

TENDONSLIGAMENTS

Determination of Death• Brain Death – Irreversible loss of Brian

Function• Circulatory Death – Irreversible loss of

Circulatory Function

In most jurisdictions the criteria for diagnosing death is not proscribed in law but rather is left to the medical profession to determine

The Steps in a Clinical Examination to Assess Brain Death.

Wijdicks EF. N Engl J Med 2001;344:1215-1221.

No Response to Painful Stimulae

Clinical Assessment of

Brain Stem Reflexes

Apnea TestTemp > 36.5BP > 90 mmHgpO2 200mmHgpCO2 > 40mmHg

Determination of Circulatory Death• Immobility• Apnea• Absent skin perfusion• absence of circulation as evidenced by absent

arterial pulsatility for a minimum of two minutes, as measured by feeling the pulse or, preferably, by monitoring the intra-arterial pressure.

When all of these criteria have been met, the patient is determined to be dead and organ removal may proceed.

Australian and New Zealand Intensive Care Society – The ANZICS statementOn Death and Organ Donation 2008

Road deaths in NSW 1970 - 1996

So is it making a difference?

Reasons why family declined donation

Some families gave more than one reason for declining donation. This is why the total number of reasons why families declined donation (150) is higher than the actual number of

non-consent to donation (97)

Source: DonateLife Audit Data 2013

Donation consent rates

Raising community awareness – the challenge

Critical fact: In Australia the family will always be asked to confirm the donation wishes of the deceased before donation for transplantation can proceed.

Challenge: For all family members to know each other’s donation wishes so if the situation arises they will uphold them.

Raising community awareness – national media campaign

Phase 1DonateLife, discuss it today. OK?

Phase 2 DonateLife, know their wishes. OK

Raising community awareness – national media campaign

10% increase to 58% - people who have had a family discussion in the last 12 months

5% increase to 56% - people who know family members’ wishes

6% increase to 70% - awareness that family consent is sought

DEVELOPMENT OF AN ETHICAL ORGAN DONOR POLICY

Legality of Organ Donation underpinned by Legislation

Development of Regulations based on Legislation

Oversight of Organ Donation and Transplantation by Health Dept. To ensure Transparency and Safety.Development of Agency to oversee Organ Donation

Institution of Transplant and Organ Donor RegistriesAuditing of agencies

Interaction with Transplant Units and Development of Policies to Ensure Use of Organs is Maximised and used by appropriately credentialed Centres

PUB

LIC

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UC

ATIO

N, A

WA

REN

ESS

&

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LVEM

ENT

DEVELOPMENT OF JUST & TRANSPARENT ALLOCATION SYSTEM

www.donatelife.gov.au 34

Australian Organ Donor Registerhttp://www.humanservices.gov.au/customer/services/medicare/australian-organ-donor-register

What can you do?