Donor dilemma for doctors, loved ones

OLIVIA CARVILLE
Last updated 05:00 29/03/2014

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Today, 700 Kiwis are on the waiting list for a kidney.

Last year, there were only 36 deceased donors nationwide.

But, contrary to popular belief, this is not because Kiwis do not want to donate their organs in death or because families are saying no.

It was largely because of a "deeply ingrained culture where we don't want to prolong the death or dying process of our loved ones," Canterbury District Health Board (CDHB) head of intensive care Dr Geoff Shaw said.

By easing the suffering of a relative who was severely brain injured, the opportunity for them to become a donor was sometimes lost, he said.

Less then 1 per cent of people will die in circumstances where organ donation is possible.

The patient either needs to be brain dead or so severely brain injured that their heart will stop beating within an hour of being removed from a ventilator.

Many New Zealand families faced with this tragedy asked clinicians to stop invasive treatments on their relatives to allow them to die with dignity, Shaw said.

"We don't want to prolong their suffering. We are practical and pragmatic people; that is our culture and the way we approach death and dying and I think that is a good thing."

If clinicians were not as upfront about the likelihood of a patient's death and if Kiwi families wanted to keep their loved ones alive for as long as possible, then the patient would become so dependent on machines they would likely die as soon as they were switched off - giving them a much higher chance to become a donor after cardiac death.

Spain holds the highest organ donation rate in the world (35 donors per million people in comparison to New Zealand's nine) however, Kiwi clinicians told The Press they believed this success rate came with its sacrifices.

Organ Donation New Zealand (ODNZ) clinical director Stephen Streat believed Spanish clinicians might be "deliberately" prolonging the death of these patients to buy time and discuss organ donation with families.

"In New Zealand the family is involved, in Spain they don't tell the family anything and it's possible that there is an intention for organ donation all along."

There were ongoing discussions among international medical communities about this practice and whether clinicians should try to keep patients on a ventilator for an extra few days to increase their likelihood of becoming a potential donor, Streat said.

However, this was in stark contrast to New Zealand's "honourable" deathcare culture. "If prolonging someone's dying ends up getting us more organs, but it's not the right thing to do, then why should we do it?" he asked.

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Streat believed it was possible to lift the organ donor rate without "compromising that very important principle".

If all potential donors were recognised by intensive care staff and every family of every potential donor was approached then the donor rate would likely rise, he said.

ODNZ has been using recent government funding to raise awareness of potential donors in ICUs around the country, he said.

Nick Cross, clinical director of the Nephrology Department at Christchurch Hospital, said a strong public education campaign on the importance of organ donation could also help drive up the rate.

Deceased donors were able to do something "tremendous" for someone else and most New Zealanders would support that notion, he said.

Extra resources in ICU could also give clinicians more time to have the difficult conversation about organ donation with families, he said.

- The Press

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