Or­gan donor suc­cess cre­ates new prob­lems


An in­crease in or­gan donors and trans­plant re­cip­i­ents has put the health sys­tem un­der “sig­nif­i­cant pres­sure” and ex­posed cracks be­tween the states that may put pa­tients at a dis­ad­van­tage.

In 2017, about 30 per cent of re­trievals and 20 per cent of or­gans trans­planted oc­curred across ju­ris­dic­tions, yet poli­cies and prac­tices in re­la­tion to wait­ing lists dif­fered, ac­cord­ing to doc­u­ments ob­tained by The Aus­tralian.

Amid con­cerns over bot­tle­necks and in­equity, par­tic­u­larly for indige­nous peo­ple, the fed­eral gov­ern­ment has launched a re­view of or­gan do­na­tion, re­trieval and trans­plan­ta­tion which will also ex­am­ine the states’ con­cerns over re­sourc­ing.

“Since 2009, the num­ber of de­ceased or­gan donors has in­creased by 106 per cent and the num­ber of trans­plant re­cip­i­ents by 75 per cent,” doc­u­ments state.

“This in­creased ac­tiv­ity is plac­ing sig­nif­i­cant pres­sure on down­stream re­sources and work­force plan­ning for or­gan re­trieval and trans­plant ser­vices.”

Although not men­tioned in the terms of ref­er­ence, the doc­u­ments show the re­view would take into ac­count “the com­plex­i­ties as­so­ci­ated with indige­nous pa­tients ac­cess­ing the wait­list”. Indige­nous Health Min­is­ter Ken Wy­att in June an­nounced an ex­pert panel would investigate and iden­tify any bar­ri­ers faced by First Na­tions peo­ple in need of kid­ney do­na­tions.

A study in the Med­i­cal Jour­nal of Aus­tralia to­day con­firms indige­nous peo­ple on dial­y­sis are “sub­stan­tially less likely” than other Aus­tralians to be placed on the wait­ing list for a kid­ney.

Re­searchers from the Uni­ver­sity of Ade­laide, Royal Ade­laide Hos­pi­tal, Men­zies School of Health Re­search and Aus­tralia and New Zealand Dial­y­sis and Trans­plant Registry found the dis­par­ity had barely changed over time.

“For peo­ple on the wait­ing list, the like­li­hood of re­ceiv­ing a trans­plant is higher in the first year and is sim­i­lar for indige­nous and non­indige­nous Aus­tralians (43.8 per cent ver­sus 31.9 per cent had trans­plan­ta­tion in the first year of wait-list­ing), but is sig­nif­i­cantly lower for indige­nous pa­tients in sub­se­quent years,” they write.

The re­searchers sug­gest the re­mote­ness of indige­nous com­mu­ni­ties, and prob­lems with ser­vice de­liv­ery, may be a fac­tor. More at­ten­tion was needed to pre­vent ad­di­tional or wors­en­ing health prob­lems among those wait-listed. “Fur­ther work at pol­icy and prac­tice lev­els is re­quired to im­prove suc­cess­ful kid­ney trans­plan­ta­tion for indige­nous Aus­tralians,” re­searchers said.

In an ac­com­pa­ny­ing ed­i­to­rial, pro­fes­sor Jeremy Chap­man, di­rec­tor of re­nal medicine at West­mead Hos­pi­tal in Syd­ney, and pro­fes­sor John Kanel­lis, deputy di­rec­tor of the De­part­ment of Nephrol­ogy at Monash Med­i­cal Cen­tre in Mel­bourne, com­ment that the sys­tem owes it to donors to “en­sure each do­na­tion counts and the out­comes for the com­mu­nity are max­imised”.

“Sur­vival match­ing or longevity match­ing is un­der con­sid­er­a­tion here too,” they write of a model that also takes into ac­count the age and other ail­ments of those on the wait­ing list.

“Qual­ity kid­neys from younger and fit­ter donors have a longer pre­dicted life­span and thus, log­i­cally, should be al­lo­cated to re­cip­i­ents with longer pre­dicted life ex­pectancy.

‘‘Those kid­neys with a shorter pre­dicted life­span are bet­ter al­lo­cated to older pa­tients with a shorter pre­dicted life­span.”

The re­view will be done in phases, with an in­terim re­port ex­pected to be dis­cussed by the Coun­cil Of Aus­tralian Gov­ern­ments Health Coun­cil at its next meet­ing. It fol­lows an in­de­pen­dent anal­y­sis of the eye and tis­sue sec­tor which is also likely to re­sult in re­form pro­pos­als next year.

‘Indige­nous peo­ple on dial­y­sis are sub­stan­tially less likely … to be on a trans­plant wait­ing list’


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