Organ donation
Organ donation can help treat disease and save lives. New Zealand has a low rate of organ donation compared with other countries. How could this be improved?
Cyclosporine
Cyclosporine is an immunosuppressive drug first discovered in 1972. It has been used to suppress the immune system in recipients of organ transplants. Neoral® is one of the brand names cyclosporine is distributed under, within New Zealand.
Benefits of organ transplants
Transplants can be used to replace diseased or damaged organs – such as hearts, lungs livers, pancreases or kidneys – with healthy, living alternatives. The organs are sourced from suitable deceased donors, but there is a worldwide shortage of available organs.
Developments in organ transplants
Transplant rejection happens when the immune system recognises the transplanted tissue as foreign and destroys it. The first successful transplant was done in 1954 when a kidney was transplanted between twins. Because the twins were genetically identical, no suppression of the immune system was needed. Since then, the use and success of transplantation has increased with:
improved immunosuppression
improved tissue typing
better techniques for preserving and transporting organs.
Organ donation in New Zealand
In New Zealand, about 400 New Zealanders are on the waiting list for an organ transplant at any one time. Most of these people (about 350) are waiting for kidney transplants. Many will die unless suitable donor organs become available. You can indicate on your driver’s licence whether you wish to donate your organs. However, your organs will only be donated if family members agree to donate them at the time. New Zealand has one of the lowest rates of organ donation internationally.
Ethical question
Would you be willing to donate your organs when you die? Why or why not? Would you accept a donated organ if you needed one to live?
Organ donation worldwide
Spain has one of the highest rates of donation – more than 30 organ donors per million of population each year, compared with about 20 in the US, 16 in the UK, 13 in Australia and less than 10 in New Zealand. In some countries, the rates of organ donation are higher than others due to social, cultural or legal factors, but invariably, all countries are unable to meet the demand for organs. Worldwide, there is a shortage of organs for transplants.
‘Opt in’ versus ‘opt out’ organ donation systems
Currently, most countries, including the US, UK, Australia and New Zealand, have an ‘opt in’ organ donation system where people say whether they are willing to donate their organs. However, the final decision on whether organs are donated is usually made by the family of the potential donor. It’s been suggested that an ‘opt out’ organ donation system could increase donations. In this system, donation is assumed to be compulsory unless people have already specified that they don’t want to donate their organs or family members refuse.
Label on organ for transplantation
Organs recovered for transplant include: heart, lungs, kidney, liver and pancreas. Once organs have been recovered, timing is essential for the success of the transplantation.
Whether an ‘opt out’ rather than ‘opt in’ system would increase organ donation is debatable. For example, Spain has one of the highest donation rates in the world, and this was unchanged when they switched from an ‘opt in’ to an ‘opt out’ system in 1979. Ultimately, organ donation system changes may ease the organ shortfall but probably won’t solve the problem.
Find out more about the ethics of organ donation.
Living or paired organ donation
A living relative or friend may be willing to donate a kidney to a patient, but they may not have a compatible blood group or tissue type. In this case, the potential donor and recipient could be matched with another pair in the same situation. This is called paired donation and may help provide organs for some people who would otherwise wait a long time.
Paired donation
A kidney can be donated from a live donor to a recipient. If the donor and recipient are incompatible, one option is to find another pair in a similar situation and make a compatible organ donation.
Alternative sources of organs
Researchers are exploring whether animals could provide organs for humans. Animal to human transplantation, or xenotransplantation, is being investigated by scientists worldwide. The technology has huge potential but first has to overcome issues with rejection, cross-species infection and ethical issues.
Stem cells are also being investigated as an alternative source of donor cells or tissue, but this work is in development and also raises ethical issues.
Useful links
The Organ Donation New Zealand website provides information and statistics about organ donation in New Zealand.
General statistics about organ donation and transplantation in New Zealand and international numbers, published on the Organ Donation New Zealand website.
donwload the PDF of the Ministry of Health's Increased Deceased Organ Donation and Transplantation: Towards a national strategy (2017), it provides detail and context for the national strategy for increasing deceased organ donation and transplantation.
The United Network for Organ Sharing (UNOS) publishes the latest numbers of people waiting for transplants in the USA and transplant operations on its homepage.
In Organ donation: is an opt-in or opt-out system better? UK researchers analyzed the organ donation protocols of 48 countries to see which approach is working best – and ‘opt in’ or an ‘opt out’ option for organ donation.
