Australia is a world leader in human organ transplantation successes, but the historically low organ donation rate has capped the number of surgeries able to take place. 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. Medical Scientist Lindsay Holder B.Sc. (Hons), worked for many years with the Australian Red Cross Blood Service in donor matching, and was gracious to give his educated insight into this complex area of medicine.
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 such as the heart, liver, lung and pancreas, as the surgical techniques for their transplantation were developed, they 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. Australia’s ethnic diversity may be one factor contributing, 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.
Having said 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.
Alexandra: According to the ABC, SBS and a variety of other sources, Australia is a world leader in transplant successes, what technologies have you seen, encountered or introduced over your years of work, has contributed to this?
Lindsay: For the first thirty or forty years of organ transplantation, all testing for Human Leucocyte Antigen typing, antibody screening and donor/recipient cross-matching 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.