Access to the Kidney Transplant Waiting List – a time for reflection

The limited availability of deceased donor kidneys for transplantation in Australia continues to be a matter of concern. Analysis of registry data suggests that the current renal transplant waiting list under-represents the real demand for three reasons. Firstly, a very low proportion of dialysis patients across all age groups are wait-listed for kidney transplantation; secondly, the percentage of dialysis patients listed for transplantation has fallen over time across all Australian states and territories; and thirdly, the number of patients wait-listed varies significantly across the country. We explore possible reasons for these issues and call for new eligibility criteria that are both transparent and justifiable and balance equity and utility

Access to the Kidney Transplant Waiting List – a time for reflection

postprintThe limited availability of deceased donor kidneys for transplantation in Australia continues to be a matter of concern. Analysis of registry data suggests that the current renal transplant waiting list under-represents the real demand for three reasons. Firstly, a very low proportion of dialysis patients across all age groups are wait-listed for kidney transplantation; secondly, the percentage of dialysis patients listed for transplantation has fallen over time across all Australian states and territories; and thirdly, the number of patients wait-listed varies significantly across the country. We explore possible reasons for these issues and call for new eligibility criteria that are both transparent and justifiable and balance equity and utility

Explaining Failure Through Success: A critical analysis of reduction in road and stroke deaths as an explanation for Australia’s low deceased organ donation rates.

ABSTRACT: During the past 20 years Australian federal and state governments have funded many initiatives to bolster organ donation. Despite large investments of time, effort and money, Australia’s deceased donation rate is amongst the world’s lowest and has only slightly increased from 11.9 donors per million people (pmp) in 1990 to 13·8 donors pmp in 2010. An often-cited explanation for this situation is that Australia’s success in increasing levels of public health and safety has reduced the number of potential deceased organ donors. We refer to this as the “Failure Because of Success” hypothesis. Although commonly accepted, this hypothesis is largely untested. Analysis of health data on road trauma and stroke deaths from Australia and other OECD countries reveals that improvements in public health and safety do not provide an adequate explanation for Australia’s low organ donor rates. Keywords: Organ donation, Public safety, Brain death, Traffic fatalities, Strok

Explaining Failure Through Success: A critical analysis of reduction in road and stroke deaths as an explanation for Australia’s low deceased organ donation rates.

ABSTRACT: During the past 20 years Australian federal and state governments have funded many initiatives to bolster organ donation. Despite large investments of time, effort and money, Australia’s deceased donation rate is amongst the world’s lowest and has only slightly increased from 11.9 donors per million people (pmp) in 1990 to 13·8 donors pmp in 2010. An often-cited explanation for this situation is that Australia’s success in increasing levels of public health and safety has reduced the number of potential deceased organ donors. We refer to this as the “Failure Because of Success” hypothesis. Although commonly accepted, this hypothesis is largely untested. Analysis of health data on road trauma and stroke deaths from Australia and other OECD countries reveals that improvements in public health and safety do not provide an adequate explanation for Australia’s low organ donor rates. Keywords: Organ donation, Public safety, Brain death, Traffic fatalities, Strok

An International Comparison of the Effect of Policy Shifts to Organ Donation Following Cardiocirculatory Death (DCD) on Donation Rates After Brain Death (DBD) and Transplantation Rates

During the past decade an increasing number of countries have adopted policies that emphasize donation after cardiocirculatory death (DCD) in an attempt to address the widening gap between the demand for transplantable organs and the availability of organs from donation after brain death (DBD) donors. In order to examine how these policy shifts have affected overall deceased organ donor (DD) and DBD rates, we analyzed deceased donation rates from 82 countries from 2000–2010. On average, overall DD, DBD and DCD rates have increased over time, with the proportion of DCD increasing 0.3% per year (p = 0.01). Countries with higher DCD rates have, on average, lower DBD rates. For every one-per million population (pmp) increase in the DCD rate, the average DBD rate decreased by 1.02 pmp (95% CI: 0.73, 1.32; p<0.0001). We also found that the number of organs transplanted per donor was significantly lower in DCD when compared to DBD donors with 1.51 less transplants per DCD compared to DBD (95% CI: 1.23, 1.79; p<0.001). Whilst the results do not infer a causal relationship between increased DCD and decreased DBD rates, the significant correlation between higher DCD and lower DBD rates coupled with the reduced number of organs transplanted per DCD donor suggests that a national policy focus on DCD may lead to an overall reduction in the number of transplants performed