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Wednesday, 24 September 2008
Page: 8532


Mr DUTTON (11:42 AM) —Proudly, Australia’s surgical outcomes for organ and tissue transplantation are among the best in the world. The clinicians in our hospitals set standards that are the envy of the world. In fact, we have a long history of organ transplantation in this country. The first transplant operation in Australia was a corneal transplant that was done back in 1941. The first kidney transplantation surgery was performed in 1956, and since then more than 30,000 Australians have benefited from transplantation.

By the time many Australians register their need for an organ or tissue transplant, they have been living for many years with chronic illness which affects their every waking minute. They might have had to endure the fatigue, the nausea and the endless dialysis procedures that are the lot of people with renal failure, or the daily struggle for breath while doing even the lightest tasks that is part and parcel of many forms of irreversible chronic lung disease. For these Australians and their families, every day waiting for the phone call announcing the possibility of a transplantation procedure is a lifetime.

This torturous need for organs and tissues for transplantation for ordinary Australians is incredibly frustrating for all of us because the benefits are so startling. Not only are our results world’s best, but indeed the Australian organ donation scheme is in fact very cost effective. A report published in 2006 entitled The economic impact of end-stage kidney disease in Australia compared the direct cost of kidney transplantation with dialysis. It found that the cost of the first year after a kidney transplant is $62,375 and the subsequent annual cost was $10,749. These costs compare with an annual cost of between $48,000 and $56,800 for dialysis patients. The report estimated that increasing kidney transplants by between 10 and 50 per cent by 2010 would save between $5.8 million and $25.9 million and substantially increase the number of years a person would have, as well as their quality of life. The report concluded that increasing the rate of transplantation would be cheaper and more effective than the usual treatments given to patients with end-stage kidney disease such as dialysis and medicines.

However, while our doctors and nurses continue to make strides forward in transplantation surgery, we are still falling down in numbers of organ donations. Australia’s rate of organ donation has failed to keep abreast with demand for transplantation. In fact, many Australians are forced to travel overseas to purchase an organ in places where this practice is legal. In February this year, the now disbanded National Clinical Taskforce on Organ and Tissue Donation handed down their blueprint report, the National Clinical Taskforce on Organ and Tissue Donation final report: think nationally, act locally. Quite alarmingly, this report revealed the fact that, over the past two decades, the general measure for the availability of organs, known as the donor rate, has declined from 14 donors per million people in 1988 to 9.4 donors per million people in 2007. To put that in perspective, by way of comparison Spain has a rate of 33.8 donors per million people, France 23.2, the USA 26.9 and the UK 10.5, according to Australians Donate, which is now closed. From the 198 Australians who donated their organs and tissues last year, 349 kidneys were received by people in need, 133 livers helped 147 Australians and there were 150 lungs, 28 pancreases, 125 corneas and 42 heart valves. These organs and tissues were all gratefully received and saved many lives, but this did not meet the enormous demand in our community. It is not that demand is falling. In fact, we are seeing quite the opposite. More and more Australians are succumbing to the so-called lifestyle diseases of obesity and diabetes, and the effect is a growing need for transplantation. This trend has developed at the same time as unprecedented increases in diabetes and kidney disease in Indigenous Australians, and the demand for organ transplantation in Australia is expected to continue to grow quite strongly into the future. According to Transplant Australia, there are currently 3,000 people—Australian children and adults—on the official organ and tissue transplant waiting list waiting for a heart, kidney, lung, liver, pancreas or corneal transplant. Tragically, of those waiting for a heart, lung or liver transplant, 20 per cent will die before they receive one. That is a heartbreaking statistic for everyday Australians in need and for their loved ones and the community.

Organ or tissue transplantation is an effective and well-established treatment that can save lives or significantly improve quality of life, especially for those facing illness, disability or premature death because of organ or tissue failure. It is often the last-resort treatment for significant illnesses and diseases. Ironically, there is an incredibly high level of community support for organ donation. There are a number of reasons why this has not translated into high donation rates in practice. The most common reason cited by families when they decline to donate a deceased relative’s organs and tissue is that they simply never asked whether or not their relative wished to donate their organs. Australians do not like to talk about death, and that will often flow on to discussions with loved ones about their feelings on organ donation. Many doctors and nurses feel awkward in bringing up the subject with relatives at a time of mourning and just cannot bring themselves to do it.

Sadly, there remains much misinformation around organ and tissue donation. Myths abound. Transplant Australia, a support organisation for transplant recipients and donors and their families, says they hear some of the best ones. For example, people fear that their organs will be removed while they are alive or that if doctors know your loved one plans to be a donor, they will let him or her die to get their organs. People often think they are too old for organ donation, but in fact the oldest organ donor last year was 80 years of age. There has also been recognition that organ donation has been largely handled on a state-by-state basis with little national co-ordination. Even within states there is considerable variability within jurisdictions and even within specific hospitals. While a variety of groups have done important work to dispel some of the more damaging urban myths around  organ donation, more work remains to be done.

I am justifiably proud of the record of Australians and the success story in this country around organ donation. I am also particularly proud of the bipartisan approach to improving the lives of Australians needing organ and tissue transplantation. In the year 2000, the Australian Organ Donor Register was established to create a better database of organ donors that would be available nationwide and to ensure that active consent was given, rather than the former tick-a-box system on the back of the drivers licence. In 2002, the Health Ministers Advisory Council, with bipartisan support, made Australians Donate the nationally recognised peak national body for organ and tissue donation for transplantation.

Australians Donate had four main objectives: maximising organ and tissue donation for transplantation, and enhancing community confidence in the associated systems; maximising the level of organ and tissue donation and the effective use of available donor organs; developing an effective and nationally consistent program and creating an environment in which Australians can donate organs and tissues for transplantation with confidence; and ensuring that ethical standards apply in the conduct of the work. This important body has now handed over its responsibilities to the cognate committee on organ and tissues under the chairmanship of Professor John Horvath.

In 2006, the former coalition government recognised the importance of bridging the gap between the demand for transplantation and the availability of organs. The then coalition government provided $28 million towards boosting our organ donation rate. In February 2006, the National Organ Donation Collaborative was established and managed by the National Institute of Clinical Studies, a body of the National Health and Medical Research Council.

The collaborative’s model was based on a similar program in the US, which has achieved a 20 per cent increase in organ donation rates in collaborative hospitals in the US. The collaborative brought together teams of experts from 26 hospitals across our country to examine the best practice models where high donation rates have been achieved. It was charged with developing evidence based guidelines to support the organ donation process. The National Clinical Taskforce on Organ and Tissue Donation was established by the then Commonwealth minister for health in October 2006 to provide evidence based advice to the government on how to increase the number of safe, effective and ethical organ, eye and tissue donations for transplantation to Australians in need. One of the first steps of the new taskforce was to hold a workshop in December 2006. That brought together a wide range of professionals and consumers to identify opportunities to improve organ and tissue donation rates.

In a bipartisan move, in that same year the Commonwealth, state and territory governments signed up to a 10-point plan to boost donation rates. The collaborative and the taskforce complement each other. The work of the collaborative directly supports the taskforce’s objectives through the development of national approaches to improve hospital processes which can be implemented at the local level. This fits well with the taskforce’s principle of thinking nationally and acting locally. The collaborative project has also provided information to the taskforce, such as recommendations to improve the identification and notification of potential donors and ideas around reforming procedures to obtain consent to donate.

In 2007, following a report from the collaborative to the then health minister, the Hon. Tony Abbott MP, several of the recommendations were progressed immediately, including the development of a national stakeholder charter for activities to raise community awareness. The then minister agreed to the adoption of clinical triggers in hospitals to identify potential donors and to the production of a national performance report. The final report handed down by the taskforce recommended that a new governance structure for the Australian organ and tissue donation and transplantation sector be established. It made a number of recommendations as to how this body should be structured. I am pleased that the government has given due recognition to this report.

The Australian Organ and Tissue Donation and Transplantation Authority Bill 2008 proposes to do three things. Come January 2009, it will see the creation of the Australian Organ and Tissue Donation and Transplantation Authority, which will be an agency under the Financial Management and Accountability Act 1997. Secondly, the CEO is to be appointed. Thirdly, it will see the establishment of the Australian Organ and Tissue Donation and Transplantation Advisory Council.

This council will advise the CEO about organ and tissue donation and transplantation measures. As the minister mentioned, the advisory council will comprise a chair and between nine and 15 members with expertise in a wide range of areas related to organ and tissue donation and transplantation. I am pleased to see the current government’s plans to continue the positive steps initiated by the coalition to ensure that more Australians become organ and tissue donors to the benefit of their fellow citizens.

In conclusion, I congratulate all of those people, from the department to the respective agencies, to people who are involved right across the country in lifting the rates of organ donation. They should be pleased and proud of the work that they undertake. They know that they are providing support and hope for many deserving Australians. I hope that together we are able to increase those rates in the years ahead for the benefit of all Australians. We support this bill.