ANALYSIS:We are in breach of a European directive in not having a co-ordinated system
THE MARKED decline in organ donation from deceased adults in the Republic last year is a huge blow to the many people who badly need a transplanted heart, lung, liver or kidney.
These patients sit quietly on waiting lists, bags packed ready for a quick dash to a transplant hospital when the long-anticipated phone call comes to advise them a matched organ is finally available.
Why the precipitous drop in donations? It’s not that the public has suddenly turned its face against the notion of giving life to others as they grieve the sudden loss of loved ones.
Rather it represents a failure of the system to resource the process adequately and to move forward as other developed nations have.
A closer look at the numbers shows that potential donor referrals dropped from 154 in 2009 to 120 last year.
This suggests intensive care staff are under such pressure they no longer have time to devote to the difficult and time-consuming process of discussing organ donation with distressed relatives.
Just 58 of these 120 referrals became donors: leaving aside the 27 who were medically unsuitable, some 35 potential donors were lost for other, potentially reversible, reasons.
Unlike most of our European neighbours, the Republic does not have a system of donor co-ordinators.
These specialist nurses must be embedded in the larger intensive care units with an outreach role to smaller hospitals in each region.
Such a system would go a long way to improving the donation process and should eliminate glaring anomalies whereby one of the State’s two neurosurgical centres (Cork University Hospital) produced just one donor last year while the other (Beaumont Hospital) sourced 14 donations.
Embedded donor co-ordinators would certainly help improve the donation rate in hospitals such as the Mater and St Vincent’s in Dublin, which despite being the national heart/lung and liver transplant units respectively have a strikingly poor track record in bringing forward deceased organs for donation.
We are in breach of a European directive in not having a co-ordinated system.
We also lack a clear legal framework for organ donation and transplantation and have failed to honour an obligation for each member state to have a national competent authority overseeing the process.
A more curious anomaly in organ donation here is that we accept only donors who are brain-stem dead.
Brain-stem death is the complete and permanent loss of function in the brain stem, the region of the brain that maintains life.
People with devastating head injuries or severe intracranial bleeding often become brain-stem dead while mechanical ventilation maintains a beating heart and circulation.
But many countries also harvest organs from people who have a cardiac death, in which the heart stops beating.
Referred to as non-heartbeating donors, they are a valuable source of kidneys, pancreas, liver and lungs. In the UK, about 30 per cent of donors fall into this category; the Irish Kidney Association estimates that if we expanded donation to include non-heart-beating donors, we could expect to see deceased donations jump to 150 donors a year.
According to the 2010 report of the organ procurement service at Beaumont Hospital, just 58 deceased donors gave organs to enable kidney, liver, heart and other transplants to be carried out here last year.
This compares with 90 donors in 2009, a 35 per cent decrease, representing the worst decline in organ donation on record.
As a result some 92 fewer transplant operations took place in the State in 2010.
It’s a situation that requires urgent but simple action from the State’s next minister for health, action that all political parties must include in their election manifestos.