Organ donations still disgracefully low

January 22nd, 2014 at 10:00 am by David Farrar

The Dom Post editorial:

New Zealand’s rates are pitifully small. This means many people die every year because they fail to get a life-saving organ transplant. The Government has made some minor reforms, which seem to have helped the rate of tissue rather than organ donations – that is, of eyes, heart valves and skin. The situation remains lamentable. What must be done?

A start would be not allowing families to over-ride the decisions of donors.

I’m a donor. If one day parts of me may assist someone to have a better life, that is a good thing. My only request is that this doesn’t happen too soon!

It seems clear that New Zealand will not lift its rate unless it is prepared to spend a great deal more money. It will have to train many more specialists in an extremely delicate area. More than half of the country’s drivers have defined themselves as organ donors. But, faced with the trauma of dealing with a family member on the brink of death, many relatives refuse to give permission for donation. Changing this will be an expensive and difficult thing. And in the meantime, many people die.

Relatives should not be placed in the position of having to give permission, It is not their permission that matters. It is the permission of the person who agreed to be a donor.

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35 Responses to “Organ donations still disgracefully low”

  1. KiwiGreg (3,218 comments) says:

    “A start would be now allowing families to over-ride the decisions of donors.” Think you mean “not”.

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  2. Longknives (4,686 comments) says:

    It always intrigues me that a lot of people don’t want to donate organs because “I don’t want to get chopped up after I die”..
    Newsflash people- Have you seen what happens to you at a Post-Mortem? (Which pretty much everyone who dies suddenly will be subjected to..)
    Might as well be a donor!

    If (God forbid) at a young age I shuffle off this mortal coil you are welcome to anything you need (liver might be a bit damaged though..)

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  3. littlebluedroid (22 comments) says:

    You should have to specifically opt out, not opt in. And family should not be able to overide. If you really didn’t want to donate fine, but people shouldn’t miss out just cause you never had that conversation.

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  4. georgebolwing (685 comments) says:

    One key reason for the low number of potential donors is that far fewer people are being killed in motor vehicle accidents.

    The “best’ potential donors are people who have “died” in an emergency room, since they can be kept on life support as arrangements are made for transplants.

    With a dramatic reduction in potentially fatal accidents, and improvements in post-accident care, there are simply less candidates available.

    In any case, I fail to see why spend a great deal more money is the answer.

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  5. freedom101 (481 comments) says:

    Does anyone know why “changing this would be a difficult and expensive thing”?

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  6. dime (9,664 comments) says:

    “I fail to see why spend a great deal more money is the answer.” – its always the answer…

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  7. nasska (10,910 comments) says:

    Isn’t the legal position of the corpse of the deceased being part of the estate the biggest hurdle to overcome? Without a law change in this respect the wishes as indicated on a driver’s license count for zero.

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  8. Evadne (88 comments) says:

    >>>Does anyone know why “changing this would be a difficult and expensive thing”?

    Because it will require a focus group, and a committee, and an inquiry, and another focus group, and some research, and another focus group to set the terms of reference for the focus group, and an overseas trip or four to see what other countries do….

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  9. KiwiGreg (3,218 comments) says:

    Pretty sure there is a market solution here.

    “If you agree to the donation of your loved ones bits, you will receive $10,000″

    ….cultural/religious objections to organ donation mysteriously vanish.

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  10. Evadne (88 comments) says:

    That said, Georgebolwing is right… as medical science & practice develops exponentially, the number of people on the transplant list increases (as people survive organ-threatening illnesses or injuries longer, and the techniques, procedures and prognosis of the various transplant ops improve) while the pool of potential donors decreases (as fewer people die in the precise state in which it is possible to harvest organs).

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  11. Albert_Ross (270 comments) says:

    Something you might find interesting KiwiGreg:

    http://offsettingbehaviour.blogspot.co.nz/2014/01/al-human.html

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  12. KiwiGreg (3,218 comments) says:

    Thanks Albert.

    I thought the US did allow payment (perhaps disguised as cost reimbursement) for blood donations, which is obviously an area where the donor could directly benefit.

    @Evadne probably the big solution will be artificial organ growth which will obviate the need for donors. Of course it will be expensive to start with.

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  13. Ashley Schaeffer (441 comments) says:

    Growing replacement organs will be the ultimate answer to this problem.

    EDIT: KiwiGreg just beat me to it.

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  14. s.russell (1,580 comments) says:

    I wrote about this in a Feb 2008 column. Som eextracts:

    In its 2005 election manifesto, Labour promised to create an organ donor register. This would enable the willing to leave a clear, legally effective, record of their wishes.

    [Labour reneged on that promise. The reason: opposition from the Maori Party:]

    Maori, and some others, had objected that the register would give people the right to dispose of their bodies as they wished regardless of the desires of their relatives, and such relatives ought to have the right to over-rule the organ’s erstwhile owner.

    Maori Party co-leader Pita Sharples explained to Parliament that Maori culture has serious sensitivities about the re-use of human tissues in another body.
    Fair enough. And no-one (at least in New Zealand) is suggesting that it be compulsory, or that it be permitted without explicit permission of the donor. The purpose of the register is simply to have that permission recorded.
    But Dr Sharples objection went one step further.
    ‘‘The proposal to prevent whānau members from being able to override the wishes of an individual is a proposal that clearly privileges the individual and relegates the collective to an inferior status,’’ he said.
    This raises an important philosophical issue. Am I ‘‘owned’’ by my culture? Do I have the right to choose what set of cultural values I sign up to?
    Most people will accept that as a Pakeha, I have the right to decide my own beliefs, and the fate of my own organs.
    But Dr Sharples is saying that if you are Maori you do not have this choice. You are to be forced, in death, to follow Maori cultural practice even if you forswear them in life and sign a legal document to that effect.
    And since we cannot be racist about this, if Maori cannot be free to choose, neither can Pakeha.

    It is a pity that Jackie Blue – who sponsored a members bill on the subject at that time, was unable to further progress this subsequently. I guess the reason may have been the same.

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  15. dave_c_ (217 comments) says:

    Indeed, in the same way that relatives should have no overriding authority over your request to donate organs, they should also remove any relatives ability to challenge my express wishes via my will!

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  16. peterwn (3,213 comments) says:

    I suspect it is a politically sensitive matter since leaving the decision to the individual may run counter to Maori and other cultural customs. Similarly ‘body snatching’ by relatives is also in the too hard political basket. A human being or body is not ‘property’ there are a few arcane exceptions – I can describe one if there is interest) and that influences the operation of the law. For example an executor is obliged to meet the deceased’s wishes, but is powerless if he does not have possession of the body.

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  17. KiwiGreg (3,218 comments) says:

    @ s.russell pretty sure those sensitivities only extend to the donating of organs; those whose life might be saved by receiving an organ tend to get over that. (there are exceptions but they always seem to involve religious nutters and children who end up dying).

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  18. metcalph (1,407 comments) says:

    Perhaps a better ad campaign is needed?

    Something like: http://www.trendhunter.com/trends/cheeky-controversial-ads-organ-donation-reborn-to-be-alive ?

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  19. Daniel (188 comments) says:

    Two solutions here.

    1. Make the dead person’s wishes all that count (family can’t over-rule).
    2. If you are a donor, then your requirement for an organ gets preference over a non-donor who needs the same organ. (not saying non-donors shouldn’t be recipients, just that other potential donors get first dibs)/

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  20. Steve Wrathall (261 comments) says:

    I’d go further and say the health system can have first dibs on any bit of a stiff they think someone else needs. Seriously. If you accept the principle behind socialised medicine, the welfare state, redistribution etc, whereby some one else’s “need” trumps your “want”, then it’s a no brainer. Sorry to sound like a knuckle-dragging leftoid.

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  21. Steve Wrathall (261 comments) says:

    Better ad campaign? No worries. Sorted
    http://www.youtube.com/watch?v=aclS1pGHp8o

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  22. Fisiani (993 comments) says:

    I used to have the job of asking family members if they would agree to their loved ones organs being used for transplant. I never had a single one decline.
    My technique was simple. I did not ask them to decide. I asked them to tell me what their loved one would have said had they been able to speak. Would they have been selfish or generous. I then asked the family to simply support the assumed wish of their loved one.
    Driving licences should have a section that you sign if you do NOT want to be a donor. That should be respected.
    Families should have no rights of refusal.

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  23. Fentex (909 comments) says:

    Relatives should not be placed in the position of having to give permission, It is not their permission that matters. It is the permission of the person who agreed to be a donor.

    I think DPF misunderstands the permission in question here; the statement this quote follows speaks to giving permission to stop heroic measures, something the patient is presumably in no position to voice an opinion on.

    Agreement to organ donation is not (as we currently print it on our driving licenses) disagreement to heroic measures and is not a Do Not Resuscitate notice.

    In such circumstance relatives are those with the authority. It’s on a patients death that their properly certified authority to donate organs should take precedence over relatives ambivalence.

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  24. wf (400 comments) says:

    Like Fisiani, I never had any rejections, but that is because I learnt very early on that Maori would not donate.
    They would always accept though.

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  25. wreck1080 (3,807 comments) says:

    Am I right in that maoris are not allowed to donate organs (against culture), but they are allowed to accept?

    I don’t get how a culture can be OK for others to break their cultural principles.

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  26. MH (690 comments) says:

    For Maori,it was a matter of taste. Some slaves were free to donate as their masters saw fit,hence the many and varied attempts to transplant shrunken heads.

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  27. Camryn (551 comments) says:

    Maori culture has serious sensitivities about the re-use of human tissues in another body.

    I don’t think this is quite right. Maori could not be sensitive to voluntary organ donation *specifically* since it was not possible at the time their cultural norms were established.

    So, what were they sensitive about? I’d say that they were sensitive about *involuntary* desecration of the dead since Maori warfare involved a certain amount of this as a psychological tactic. Naturally, since there was involuntary re-use or misuse of human tissue going on, it became codified in the culture as something to be sensitive about. Organ donation has been conflated into this for no particularly good reason as far as I can tell.

    Surely we just need modern Maori leadership to say “Respect for the dead is important in our culture. Consented organ donation is considered respectful. Both individual and whanau mana are enhanced, not diminished, by voluntary organ donation.”

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  28. Tookinator (216 comments) says:

    round 50 – 60% of eligible organ donors families currently say no to their relatives organs being donated in NZ.
    We need to target this area in several ways.

    (1) Offer a funeral grant to the donors families. More people would sign up as a donor if they thought it would take the financial pressure off their family at an already traumatic time. Or offer tax credits. The government currently pays out over 3 million dollars a year in funeral grants to other less deserving cases. The very people who save the health system money, contribute to the community, save up to 10 other peoples lives, and who are the real heroes of society get nothing…

    Offering a funeral grant is not money for organs – it is a recognition of their gift to society. The deceased does not benefit financially and neither does the family as it would be produced by redeemable funerals services vouchers only.

    (2) A public awareness campaign: We have the TV ads on speeding, drink driving etc in order to save lives. Why not one on organ donation to save lives? Ads would get more people discussing the issue and family members would then know each others wishes should an accident happen.

    (3) Survey those families who said no (as they are now doing in Aus) to find out why they said no so that we can apply resources to the area it is lacking in (In the eyes of the families.)

    (4) Only around 55% of drivers have ‘donor’ on their licence. You can bet that 99% of them would accept an organ if they needed one to live!
    On the driving licence application form where it asks “do you want to be an oran donor? yes/no” precede that question with “would you accept an organ if you needed one to live? yes/no
    Most will tick yes to that first question, it will make them pause for thought before they tick no to the next question. They may realise that without donors there are no recipients either…

    (5) Presently you stand in a line at the AA shop or wherever to get your licence with no prior information on donation and then have to make a desicion there and then on being a donor – It is not informed consent. We go to get a new licence, not to be a donor.

    It should come off the licence (as it will cost you $32 to change your donor status) and be web based. We have secure banking, Census and so on why not donor registration? Instead of being on your lonesome at the AA office trying to decide you could be at home with your family gathered around the computer where you all find out the benefits and myths. You could change (for free) which organs and however often you like. Unlike the current system of yes or no to all organs – all or nothing… Some people tick no on their licence because they don’t want to donate their eyes for example but are happy for all other organs to be donated. The present licence system doesn’t allow you to choose just some organs.

    (6) Consider an opt out system as opposed to our current opt in system (As has just happened in Wales) It is not the “State stealing your organs” as some hysterics would have you believe, as you CAN STILL OPT OUT!

    (7) consider a priority scheme – i.e. a registered donor will go higher on the wait list than a non donor. The current system is unfair. I could go around the country promoting people to sign up as a donor. The guy next door could be totally opposed to being a donor. The next day we could both be in need of a new kidney, we will both go on the list as equal, he may even get one before me! It goes back to no donors, no recipients. And also “No Give – No Take.”

    (8) A reputable marketing company should be given the job of promoting/advertising organ donation. Not the current organ donor service. They may be good at doing the medical side of things, but marketing is outside their area of expertise.

    Just continuing to throw good money after bad by keep giving more money to ODNZ has proven not to work over the past decade. Despite extra funding donor rates went down last year.

    It is time to try new approaches, think outside the square, and for the Health Ministry/Minister to keep putting it in the “too hard basket.” By just throwing a couple of million at the problem now and again doesn’t fix the problem but gets the Minister out of a political problem if asked, as he can pass the buck by saying, “Well I’ve given them money it’s up to them to sort out.”

    It needs political leadership with a proactive stance. Minister Tony Ryall needs to do what other Health Ministers have done around the world and give them a rocket.

    Andy Tookey
    http://www.giveLife.org.nz – Campaign for Organ Donation Reform

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  29. beautox (436 comments) says:

    9) Encourage more motorcycle riding. Promote the wonders of touring NZ on a big powerful motorbike.

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  30. Chuck Bird (4,765 comments) says:

    Since no political party will take a position on this this is the sort of thing that should be decided by a binding referendum. Wording is not a problem. The legislation would first have pass a final reading and would not become law till ratified by a binding referendum.

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  31. trout (919 comments) says:

    ‘Maori Party co-leader Pita Sharples explained to Parliament that Maori culture has serious sensitivities about the re-use of human tissues in another body’. But no cultural objection to ingesting human tissue.

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  32. Jaffa (84 comments) says:

    You can’t be a recipient until you have been a registered donor for at least 12 months!

    That should encourage people to sign up!

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  33. Ezekial (5 comments) says:

    According to Dan Ariely, whether the choice given when capturing the persons preference is “opt out” or “opt in” makes a big difference.
    see; http://danariely.com/2008/05/05/3-main-lessons-of-psychology/ for the details.

    It would appear that changing the enrollment choice from opt in to opt out could increase the pool of potential donors significantly.

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  34. Crusader (294 comments) says:

    The fact is that the dead have no rights. Actually the ownership of the corpse should rest in the coroner, i.e. the state, who could then make a decision regarding donation or not (i.e. donation unless a compelling reason why not). The wishes of the bereaved should be of no matter. Their consideration for the greater good of the living should trump their superstitious squeamishness.
    But that’s just how things should be. I know we are a long way from a reason-based society which can accept that.

    Actually there are relatively few candidates suitable for organ donation. They really have to die in an intensive care unit, i.e. be brain dead and on a ventilator which is switched off. I recognise the compelling need for greater acceptance of organ donation amongst the general public. The issue is close to home for me.

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  35. Kea (11,878 comments) says:

    This one is easy to solve:

    1. Everyone has the right to chose according to their beliefs.

    2. No one gets free state funded medical care unless they are a donor.

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