Organ donation in Australia and New Zealand--ICU perspectives.

Point of view a) that organ donation is the only possible positive outcome that can occur in the setting of brain death, b) that for many families organ donation can assist with easing the pain of loss and, Organ donation in Australia and New Zealand – ICU perspectives c) that fulfilling the wishes of the donor is the primary consideration. Implicit in this culture is that “to donate organs” is more desirable and of greater moral value than the contrary decision, particularly if organ donation was the previously expressed wish of the dead person. This moral value judgement draws upon societal values regarding individual obligation to contribute to “community or common good” versus individual autonomy and liberty. Intensivists have been aware of the benefits of organ transplantation in Australia and New Zealand since the advent of kidney transplantation in the 1960s. Furthermore, we have the unique dual responsibility of facilitating organ donation and in caring for transplant recipients. As intensivists we are strongly supportive of organ donation and transplantation as we have seen many patients benefit. However, we do not believe that promoting organ donation is the primary responsibility of an ICU specialist. Our primary responsibility is to do our utmost to restore quantity and quality of life. If that is not possible then we must do what we can to protect the dignity of the patient and his or her family. This means: As transplantation has become more successful over the last 15 years and many previous contraindications overcome, the demand for organ transplantation has risen worldwide; consequently the shortfall of organs to meet the demand has become more pronounced. This has led transplant professionals, in particular, to champion endeavours to increase organ donation rates. a) frequent, honest and open communication with the family regarding the prognosis, the process involved and the family’s choices, Over the same time period there has been a reduction in deaths from trauma in the industrialised world (including Australia and New Zealand). Previously, patients dying from traumatic brain injury constituted the largest group of organ donors and these patients were most often young and in prior excellent health. Organ donation rates in Australia and New Zealand have not changed substantially over the last decade but spontaneous intracranial haemorrhage is now the most common cause of death in organ donors. These donors are older and more often have cardiovascular and other co-morbidities. b) full, unbiased and timely information about organ donation, c) full support to the family (i.e. provide adequate time to understand and accept death, brain death and organ donation; provide adequate time for the family with the patient; provide a private room for discussions, etc) and, d) support the family in making a decision that is freely made and which they can live with in the future. In this activity lies a rich source of professional satisfaction and the opportunity to reduce our feelings of anxiety and unease about our role in organ donation. Best practice does not mean achieving the family’s agreement to organ donation. It means that the family was supported in the process of considering or fulfilling the potential donor’s wishes and making the “right” decision for them. This “right” decision is the one that they can best live with comfortably for the rest of their lives. It is arrived at when all the professionals involved provide timely, full and unbiased information about organ donation and adequate time and support to the family such that they freely consent or do not consent. Historically in Australia and New Zealand the request for organ donation was made by a transplant professional, usually a renal physician requesting kidney donation. Over the last 15 years this role has become the responsibility of the intensivist.