National News Health Report
Australia is a well documented world leader in human organ transplantation successes, but the somewhat inexplicably low organ donation rate has capped the number of surgeries taking place, as demand outstrips supply. However, with the recent momentum of Government community programs and awareness campaigns, focusing on culturally and religiously diverse education and recruitment programs, in the last two years statistics have show a steep upturn in deceased donor rates in Australia. Recently retired Medical Scientist Lindsay Holder B.Sc. (Hons), worked for years with the Australian Red Cross Blood Service in donor matching, gives his qualified and educated insight into a sometimes misrepresented and little understood field of medicine.
Written sourced and edited by Alexandra McDonald
Alexandra: Australia has typically had a very high organ transplantation success rate, but a very low deceased organ donation rate. The factors that cause this are complex, but what, in your opinion, are the most prominent factors creating this disparity between the two, and what accounts for the recent upturn?
Lindsay Holder B. Sc. (Hons): Organ transplantation began in Australia in the mid 1960’s. Organ donation programs, organ transplant units and laboratories specializing in transplant immunology were established in the major capital cities and have continued to grow and to adopt new technologies ever since. This has meant that transplant success rates, firstly for kidney transplantation and later for other organs (heart, liver, lung and pancreas) as the surgical techniques for their transplantation were developed, have remained of world best standard. Demand for donated organs has always outstripped supply and the reasons for low deceased donor rates per capita compared to most other countries have continued to perplex professionals working in this field.
This disparity has been greatly offset for kidney transplantation by the development of living donor transplant programs where a consenting and healthy relative or friend, after an exhaustive screening program, donates one kidney to a person in need of transplant. In Victoria and Tasmania, almost half of kidney transplants are sourced in this way.
Australia’s ethnic diversity may be one factor with many cultures greatly under-represented in the donor population compared to the proportion of patients from these groups requiring transplants. Religious and cultural attitudes to donation may contribute to this and education and recruitment programs have focused on these groups.
Another possibility is that Australians may be reluctant to discuss matters such as death and organ donation in everyday life and family decisions about donation are then left until after a family member has died. In this time of shock and grief, families are less likely to reach mutual consent when faced with the necessity to decide quickly and may feel under pressure from health professionals whose duty it is to seek consent for donation. There has been a great deal of government input and spending in recent years to address this problem through community advertising and education programs and the employment of more organ donation professionals with the result that the donation rate has shown a rapid rise in the last couple of years.
Alexandra: According to the ABC, SBS and a variety of other sources, Australia is a world leader in transplant successes (and if I may pause here and thank you for your contribution!), what technologies have you seen, encountered or introduced over your years of work, that has contributed to this?
Lindsay: For the first thirty or forty years of organ transplantation, all testing for HLA (Human Leucocyte Antigen) typing, antibody screening and donor/recipient crossmatching employed serological testing techniques where antigen/antibody reactions were directly observed microscopically using the microlymphocytotoxicity assay. The focus has almost entirely shifted to detecting the gene sequences that code for these antigens and antibodies using techniques such as PCR (polymerase chain reaction), Gene Sequencing and Flow Cytometry and the specificity and accuracy of information so obtained has further improved transplant outcomes and enabled the successful transplants of patients with reduced likelihood of finding a suitable donor.
In addition to the great advances in the laboratory techniques themselves, enormous changes have occurred in the information technologies used for the storage, management and communication of the vast amounts of data generated by these technologies and for the calculations, decisions and reporting now possible. Without the improvements possible in specimen handling, laboratory workflow, automated testing and processing and automated reporting (and, of course, billing) the technical advances in the laboratory could not have been successfully implemented.
An example of a recently introduced program that would previously been impossible is the “Paired Kidney Exchange” program which maximizes outcomes for patients with potential living donors for whom they are incompatible by finding other such pairs of donor/recipient and assessing the suitability of each donor for other recipients.
Alexandra: In the media coverage of this field over the years, what misconceptions or misrepresentations have you observed?
Lindsay: Understandably enough, focus in news reports, popular science programs and television medical dramas is placed on “firsts” in transplantation and on dramatic situations, often involving children.
News coverage often includes transport of donor organs (the “Esky”) and on time constraints (rushing to the waiting chartered jet at the airport, late at night) when in reality, organ transplantation has become quite routine and such dramatic situations are rare.
The amount of work over months or years in assessing and preparing patients for transplant and, at the time of donation, (often late at night and with pressing time constraints), the hours involved in typing, organ allocation and cross-matching is rarely acknowledged or understood. To be fair though, some programs have taken a great deal of trouble to include this as part of the process.
While such coverage has generally been good for the promotion of organ transplantation there have been occasions where errors or omissions have been made or donor anonymity has been breached. A strict code of practice exists in Australia regarding organ transplantation, which is in place to ensure that people are not dissuaded from donation or that donor families and organ recipients cannot identify one another.
Although the organ donation rate has risen over the last few years, the Australian transplant medical community is still in limited and short supply. It is within our power to help our fellow Australians, to save a life, to be altruistic, to be a hero to someone desperately in need of help. To register, go here, and to see the latest statistics, go here.
Everyone has the powerful potential to leave a lasting legacy, to help someone else. One day you, a loved one, a family member, or someone you know may need a transplant- although it is this writer’s most sincere hope that this will never happen. But if one day it does, who will be registered to save your life?