Organ donations
March 1st, 2012 at 7:00 am by David FarrarAn old but important post by Eric Crampton:
NZ’s organ donation regime is an inefficient nightmare that kills people. Donor’s wishes, expressed via their drivers’ licence, aren’t taken as binding and can be overturned by anyone claiming a connection to the potential donor. Even suggesting that folks signing up to be future organ donors get bumped up the waiting listgets folks riled up, though there were some encouraging noises two years ago about maybe allowing that Kiwi donors be compensated; similar calls for compensation came up in the UK last year. As it stands, Otago’s med school is allowed to cover funeral costs for cadaveric whole body donations, but nobody’s allowed to cover funeral costs for organ donors. There are all kinds of policies that would improve on the status quo but haven’t been explored, at least in NZ.
I think the current practice where donors wishes are not binding is a terrible thing.
Eric blogs on Israel:
Living donors are now paid 40 days’ lost wages plus a very generous expenses allowance. Folks with family members on the waiting list can request to become living donors for other people on the list and are then matched with other folks in the same circumstances: a “chain of living donors” not unlike the American MatchingDonors service. Result?
Israel experienced a dramatic increase in the number of organ transplants in 2011, totaling 384, 68 percent higher than the previous year, although the number of transplants performed in 2010 was particularly low. Kidney transplants from deceased donors were 2.37 times greater in 2011, with 123 operations, than in 2010. There were 69 liver transplants from deceased donors in the past year, 2.15 times as many the previous year, 59 lung transplants, representing an 84 percent increase, and 23 heart transplants – 2.09 times the number in 2010.
Excellent. And further:
The Priority Law, which takes effect in April, will give holders of Adi donor cards priority if they ever need a transplant.The number of cardholders has considerably increased recently following a publicity campaign touting the new law. Anyone signing the card before April will be immediately eligible for the benefit, while those signing after the law goes into effect will need to wait three years for eligibility after signing.The number of organ donor signatures rose 71,229 during the year to a total of 632,300 while another 20,000 requests for the cards are being processed by the National Transplant Center.
March 1st, 2012 at 7:17 am
I put myself down to donate organs and would be annoyed if anyone overrode my wishes. As I haven’t died young my organs are now past their use by date. I wonder if organs are lost because people die without their drivers licence handy. If it takes a while to identify them the window for organ removal might be lost. I suggest a small tattoo mark be made on the body in an inconspicuous place. If that persons wishes can’t be overridden the organs could immediately be taken. While this might upset some relatives I think the rights of other people dying should take precedence.
Vote:March 1st, 2012 at 7:22 am
Would there be a potential Treaty claim on this? The natives do not like donations or transplants.
Vote:Of course, some koha could smooth the way to an agreement.
March 1st, 2012 at 7:28 am
It is not a matter of dying but when you die. If you are killed in a road crash your organs are generally wasted. Too much time between death and harvesting. You need to be just maimed to the point where you are a vege on life support that will get switched off once your organs have been typed and suitable recipients on the list found. I am sure some medicos will correct me if I am wrong.
Vote:March 1st, 2012 at 7:51 am
There’s another factor at play here.
New Zealand has an opt-in procedure for organ donations.
Although the vast majority of people approve of organ donations only a small number will grant permission because it requires the person to take an active step.
The low NZ rate of organ donations also occurs in other countries with opt-in procedures. In America 85% approve of organ donation, but only 28% have actually granted permission. Australia (14.9 donors per million, 337 donors in 2011), Denmark (4% participation), UK (27%) and Germany (12%) also have opt-in procedures.
Contrast these with Spain, France, Italy and Belgium which have opt-out procedures – every-one is a potential donor unless he or she requests not to be. Even with cultural and infrastructural factors, public policies and other factors, the organ donation rates are much higher.
Vote:March 1st, 2012 at 7:52 am
Law should be changed so that doctors can freely harvest any dead (or brain dead) person. The dead don’t care, and family feelings should have zero weight when others lives hang in the balance. Is there any rational argument against this? (other than high cost for short life of some higher risk procedures like heart transplants).
As for encouraging live organ donors to move up the list, you could have people paying others to become donors so that they can move to the top of the list. Maybe that wouldn’t be so bad if you had enough checks and balances, but it could also encourage creep towards less voluntary systems (and threat of losing a loved one is already duress of sorts).
Abuses are already happening outside the West (Eg China farming prisoners, other organ transplants and ‘theft’ in 3rd world). Recent movie “Never let me go”, and fiction works of Larry Niven paint pictures of some of the scarier scenarios.
Vote:March 1st, 2012 at 7:57 am
At the root of this and ‘body snatching’ issues is the legal concept that a human body is not ‘property’. Perhaps the time has come to regard a deceased body as the property of that person upon death and treat it as part of the person’s estate. The person can then give partial or full instructions as to disposal in a will or other means (eg organ donor via driving licence). There would need to be legal safegurds so a person cannot ask for some ridiculous thing to be done, similarly anyone with ‘charge’ of the body. There would need to be a positive obligation to properly bury or cremate it unless donated to a medical school.
Vote:March 1st, 2012 at 8:03 am
@ Brian not correct. In fact suicides and car crashes are an important source of organs for transplant. People who die of natural causes (or diseases) are generally unsuited. There is a timing element involved of course. My wife used to work as an organ transplant co-ordinator and she would often be the second person the deceased’s relatives talked to after the cops had been with the bad news.
@ Joe also not correct. Most people in fact list themselves on their licences as donors. The problem is as the article says that it isn’t binding. Next-of-kin can (and do) override the wishes of the deceased.
@ manolo needless to say Maori (and to a lesser extent PI people) have VERY low donation rates (often because of the next of kin issues). The queue for recipients is of course colour blind).
Vote:March 1st, 2012 at 8:03 am
Here’s a riddle for you:
A heart donor and his donee met on a fun run after the procedure, and become close friends for the rest of their long lives.
How could this be?
Vote:March 1st, 2012 at 8:04 am
Incidently Iran of all places has a very succesful live organ transplant program, involving payment.
Vote:March 1st, 2012 at 8:43 am
IMHO ‘peterwn’ has cut to the heart of the matter (pun intended). Decisions taken at a time of extreme emotional distress are very often the wrong ones & a bereaved next of kin are not necessarily responding logically.
If legislation making the deceased’s body part of his/her estate were to be enacted it would absolve the next of kin of the responsibility of making a decision on the spot & would allow the wishes of the deceased to prevail.
Vote:March 1st, 2012 at 9:02 am
@kiwigreg – does their program involve ‘consent’ ?
Perhaps a sensible place for recording ones organ donor wishes would be on the birth register? The challenge with having this info held in Will documents could be locating these quickly enough for a donor’s wishes to be carried out
Vote:March 1st, 2012 at 9:08 am
Nasska, the shysters would love that but it wouldn’t solve the problem.
A body is dead meat – let the doctors have what they need when they need it.
Vote:March 1st, 2012 at 9:08 am
Jonno – he’s a Timelord?
Vote:March 1st, 2012 at 9:10 am
Having been involved in trying to work this issue out in the past the biggest obstacle by far was maori beliefs with whanau having the ability to completely overturn the prior wishes of the deceased. Its bloody ironic considering that it is maori who disproportionately need organ transplants much more than europeans and will generally get a better tissue match with a fellow maori. It is almost impossible to have a rational discussion with the so called maori representatives on this issue as up comes the usual superstitious mumbo jumbo to stuff everything up. Whilst I have sympathy for the individual maoris involved languishing on the list waiting for a suitable tissue match until maori as a whole drag themselves into the 21st century and ditch some their increasingly maladaptive superstitious beliefs they will continue to miss out on what modern medicine can deliver.
Vote:March 1st, 2012 at 9:20 am
There is an easy answer to the shortage of organ donors!
You can’t be a recipient unless you have been a registered donor for at least 12 months!
Problem solved!
Vote:March 1st, 2012 at 9:21 am
@ sifty yup 100%
@ kk yes it does – it’s an interesting combination of religious belief (and action) coupled with some sensible financial rewards (typically but not always from the donee family). China is more the place for criminals ending up in the involuntary organ donation program.
Vote:March 1st, 2012 at 9:22 am
Just make the DL option legally binding.
Vote:The drivers license option covers significant numbers of people sufficient to insure a ready supply of bits if it is legally binding.
I donate my corpse to science as a bonus it saves the excessive cost associated with disposal of my Cadaver.
March 1st, 2012 at 9:23 am
@ Billl if only it were that easy. The first thing to do should be to make the individual’s election to be a donor binding (i.e. not able to be overturned by next of kin, but try getting that past any government kowtowing to Maori). Research into cloning, artificial (biological) organs would be great (but of course is badly hampered in NZ by our anti-biological science laws).
Vote:March 1st, 2012 at 9:27 am
@PIA – haha, good one, but no, both real people. Here’s a hint: heart/lungs.
Vote:March 1st, 2012 at 9:39 am
jonno…
Donor is registered, still has his heart but has already donated a lung.
Vote:March 1st, 2012 at 9:45 am
# sifty (10) Says:
March 1st, 2012 at 9:10 am
Having been involved in trying to work this issue out in the past the biggest obstacle by far was maori beliefs with whanau having the ability to completely overturn the prior wishes of the deceased. Its bloody ironic considering that it is maori who disproportionately need organ transplants much more than europeans and will generally get a better tissue match with a fellow maori. It is almost impossible to have a rational discussion with the so called maori representatives on this issue as up comes the usual superstitious mumbo jumbo to stuff everything up. Whilst I have sympathy for the individual maoris involved languishing on the list waiting for a suitable tissue match until maori as a whole drag themselves into the 21st century and ditch some their increasingly maladaptive superstitious beliefs they will continue to miss out on what modern medicine can deliver.
Hear hear. Solution seems simple enough: make the decision to donate binding and bump donors to the top of the waiting list. If you’re not willing to donate then you shouldn’t be expecting other people’s organs for yourself. Children excepted of course.
On the other hand, by the time Maori get around to changing their attitude we’ll probably already have organs grown to order.
Vote:March 1st, 2012 at 9:46 am
Sifty – yep, it sucks that the ones that need a liver are held up by the ones that need a brain
Vote:March 1st, 2012 at 10:08 am
@Northland Wahine, that could work, except a one-lunger would probably not be participating in a run.
Correct answer: donor had duff lungs (congenital, not smoking) but an excellent heart; received a heart-lung transplant from another (deceased) donor, and donated his heart to the donee. Apparently it’s easier to transplant heart & lungs together than lungs alone when the problem is with the lungs, probably less re-plumbing involved, but heart transplant only is OK (medicos might correct me on this).
Vote:March 1st, 2012 at 10:17 am
What Israel has done is simple economics. Why are people surprised it works?
Vote:March 1st, 2012 at 10:36 am
My view on donation is that the wishes or of the deceased should be legally final and that if someone isn’t on an organ donor list then they are not eligible to receive a donated organ. Unless there is a reason their organs are somehow unfit for transplant. Belief in a the supernatural is not a valid excuse, sure don’t donate, but dont expect to be on the waiting list for a kidney. I am registered as a donor and wouldn’t want my family to go against my wishes and disallow the donation.
Vote:March 1st, 2012 at 10:39 am
@ sean667 one of the most important things you can do then is talk to your family and make sure they know what your wishes are.
Vote:March 1st, 2012 at 11:22 am
Yep, not a donor do not get a transplant.
Vote:Some of us have living wills setting down that we are donors, and my wife and lads have signed the will that sets out my wishes.
Whanau, hmm, none of them will cross my lads and with a living will no one outside the immediate family has any standing.
March 1st, 2012 at 11:47 am
As many will know, I have campaigned on this for the past 10 years. I have taken it to Parliament several times.
I got the support of Jackie Blue and we worked on a Private Members Bill. The Bill got drawn and went to Select Committee. The Bill was quite straight forward. If you sign up as a donor (or equally important not a donor) then no one could overturn your wishes.
I also wanted a binding organ donor register. The current practice of having it on your driving licence doesn’t work for many reasons. (1) when you go for your driving licence, you are going for just that, not with any thought about organ donation or prior ‘informed consent’ consequently many people tick ‘no’ as their only knowledge of it is from poor sources such as Soap Operas and Horror movies!
Driving licence is a legal document – but the donor part is not.
It excludes non drivers
You can’t change your mind on your licence until it’s renewed 10 years later.
I proposed having it online. Families could sit together and learn about it and sign up. They could change their mind about being a donor or what organs they wish to donate as often as they wish and it would be easily accessible by doctors (Instead of people searching for your wallet in scrubland after a car crash – or trying to get hold of family overseas on holiday for a desicion. (Why do they need a 2nd permission anyway? they already have the permission of the person who owns the organs!)
Banking and Census are online, why not an organ donor register?
Why should my long lost brother (who I haven’t seen for 20 years) be able to overide MY choice to be a donor? Why does his religion or culture overide my lack of one?
Jackie’s Private members bill was biffed out in favour of a government bill, which gives an even wider range of people the right to veto your choice!
I proposed other ideas also – Like if you sign up to be a donor you move up the list should you ever need a transplant. This in turn creates more donors and saves more lives. The goal of transplant system? No apparently not, all these ideas have been rejected.
Under the current system I can advocate for people to be donors and really push the message. My next door neigbour could be totally against being a donor and say ‘I want to be buried whole – nobody is getting my organs.’ Next week we could both need a liver transplant and yet we would go on the register as equal. In fact he may get the organ before me!
I’s like awarding the Lotto prize to someone who didn’t buy a ticket…
There are some cultures in NZ who refuse to be donors but are first in line when they need one.
As a result I launched a ‘Private Organ Donor Register’ Where members agree to be a donor but stipulate that their organs go first to another registered donor. (Directed donation – perfectly legal in NZ – Grant watshisname directed that his kidney go to Jonah Lomu.)
My launch of this scheme got world wide attention – and since has been launced by the governmet in Israel!
Of course in NZ not only was it rejected by the government but days after my launch a new rule was announced that you can’t direct where your (deseaced) organs can go.
The organ donor service said they would reject organs offered in this manner.
So the current practice is that they will chuck away perfectly good organs and let several people die on the waiting list because they don’t agree that you should decide where YOUR organs should go! (This small bunch of doctors who control NZ’s organ donor rates obviously have a much higher and better morals and ethics than us great unwashed.)
Now before anyone on the thread starts on about it being a slippery slope of deciding where the organs go check out the website first so that you are fully informed before commenting: http://www.lifesharers.org.nz
I’t not about excluding people i.e. obese or smokers it is an incentive scheme. Giving organs first to Catholics doesn’t produce more Catholics, or giving organs first to businessmen doesn’t produce more businessmen! But giving organs first to other registered donors creates more donors = saving more lives.
Even the most selfish of people would sign up if they thought it would give them a better chance of a transplant if they need one.
(Doesn’t matter if physically you can’t be a donor due to medical reasons – you are not excluded – No one is too sick to OFFER to be a donor, wether they use your organs or not.)
Ok, The other thing I have been pushing for years is for a funeral grant for those people who become donors. If people thought it would take the financial burden off their family for funeral costs at what is obviously going to be a traumatic time they would likely to sign up as donors. (No incentive at the moment.)
It would also be a small recognition for the donor who would have saved, or improved the quality of life for up to 10 people by deciding to be a donor. (It also save the health system heaps as ONE organ donor gets a heap of people off expensive medical treatments. (Dyalisis etc.)
Even those ‘cultures or communities’ who refuse to let their relatives be organ donors on cultural grounds may change their mind if there was money involved!
Another suggestion I had (and again rejected by the government.) was if donor is to remain on the driving licence (against all good judgement.) Then they should add a question BEFORE the current question of ‘Do You Want to be an Organ Donor?’
Yes/No.
Before asking that question, the question prior to it should read: ‘If you needed an organ in order to live would you accept one?’
Just this week I got another letter from the Minister of Health rejecting all ideas etc saying that there is no evidence it would increase donors etc, etc,
But I note many other countries are now doing what I was proposing in my submissions to Parliament 10 years ago. And I am constantly seeing news reports from these other countries that their donor rates are skyrocketing.
Meanwhile NZ still has the lowest organ donor rate in the Western World.
10 years ago the organ donor rate for that particular year was just 38 donors for all of NZ. Parliament were ‘very concerned’ about that low figure. Guess what, just a few weeks ago the figures for the number of donors for last year were released. Yep 38 donors for 2011.
I’m assuming therefore that the MP’s will be equally ‘concerned’ this time round and will do something about it?
Well in my latest letter from the Minister he says they will continue doing what they have been doing….
What’s that saying? ‘Do what you’ve always done and you’ll get what you’ve always got.’
P.s. my other website is http://www.givelife.org.nz
Vote:March 1st, 2012 at 12:29 pm
@ Bob – 7.17am – people can donate organs into theri 80′s – don’t tick ‘no’ to being a donor because you ‘think’ your organs are not usable – let the doctors test them at the time! (organs are taken often from smokers/drinkers and diseased people.)
@Manalo – 7.22am – I had a police escort off a Marae when I was there to discuss organ donation – The Treaty was actually broght up! I pointed out that at that time not only were they not doing transplants but that they were still eating each others organs then!
The whole argument of being buried whole – So they don’t mind having a kidney cut out and replaced with someone elses?
They want to be buried whole but still agree to have their appendix/tonsils/masectomy removed but not an organ after their death to save other lives?
@Brian Smaller – 7.28am – pretty much right. Chances of becoming an organ donor a very slim. Chances of needing an organ much higher. You can’t die in a car crash and be a donor. A donor must be in ICU at the time of their death. (So that the organs can be ventilated to prevent rapid deterioation.) Also death has to be brain death – head injury/anerysm/ or now heart attack (I think only 1 donor from that last year.)
@Joe Bloggs – 7.51am – I proposed an opt out system – it is easier to track the 2-4% who don’t want to be donors than the 96% who do want to be donors. Can’t ever see it happening here (unless a politician child ever needs a transplant.) A lot of people feel the opt out system is ‘The State’ stealing their organs.
Vote:March 1st, 2012 at 2:19 pm
One of the main reasons why Jackie Blue’s Private members Bill on a binding organ donor register was rejected was because the ‘organ donor doctors’ kept telling the Health Select Committee that it was ‘very rare that families veto an organ donors wishes’ and therefore no law change was required.
I argued that they were hiding the figures – They were refused to me under the OIA.
The Select Committee obviously took the nice truthful doctors at their word and discarded my evidence.
A few years on and i’m now finding out that it is not ‘very rare’ but up to 50% of the time!
Maybe Jackie should resubmit her Bill into the Ballot?
Vote: