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Organ Donation and Transplantation 747

objection (see Table 27.1). In Australia, New Zealand, the health departments and funding arrangements between
US, the UK and most other common-law countries, the federal and state health departments.
approach is to ‘opt in’, with specific consent required As part of the national reform package for the organ and
6,7
from the potential donor’s next of kin. In some states tissue donation and transplantation sector, all state and
of Australia (for example, New South Wales and South territory health ministers agreed to the establishment of
Australia) and in New Zealand people indicate consent a national network of organ and tissue donation agencies,
to organ donation on their driver’s licence or namely the Organ and Tissue Authority. This involved the
the Australian Organ Donor Register. 8,9,10 In Singapore, employment of specialist hospital medical directors and
the Human Organ Transplant Act of 1987 combines a senior nurses to manage the process of organ and tissue
presumed consent system with a required consent system donation as dedicated specialist clinicians employed
for the Muslim population. The informed consent legis- within the intensive care unit. 1
lations of Japan and Korea are two of the most recent to
come into force, in 1997 and 2000 respectively; before The responsibility for leading this group of dedicated
then, only living donation and donation after cardiac health professionals rests with the National Medical
death were possible. 11,12 Director who supports this team through a Community
of Practice (CoP) Program. This community of health
LEGISLATION professionals, along with the staff of the Authority, are the
Legislation governing organ and tissue donation in New DonateLife Network, working together to share informa-
Zealand and Australia take the form of Acts covering the tion, build on existing knowledge, develop expertise and
1
use of human tissue both before and after death. These solve problems in a collaborative and supported manner.
legislations enable a person to choose to be a donor, and
organ donation can proceed unless that wish is reversed THE ORGAN AND TISSUE AUTHORITY
or the family does not consent. If the deceased’s wishes Legislation governing organ and tissue donation in Aus-
are not apparent, consent for organ donation rests with tralia is based in State and Territory jurisdictions. Solid
the next of kin. In Australia the legislation defines death organ donation agencies are based in New South Wales
as the: (in partnership with the Australian Capital Territory),
l irreversible cessation of all function of the brain of Victoria (with Tasmania), South Australia, Northern
the person or Territory, Queensland and Western Australia. Separate
l irreversible cessation of circulation of blood in the state-based tissue banks facilitate tissue retrieval around
body of the person. 13 Australia apart from Western Australia, where the organ
donation agency coordinates all organ and tissue retrieval.
TYPES OF DONOR AND DONATION The Organ and Tissue Authority is the peak body that
works with all jurisdictions and sectors to provide a
Organ and tissue donation includes retrieval of organs nationally coordinated approach to organ and tissue
and tissues both after death and from a living person. donation for transplantation to maximise rates of dona-
Donations from a living person include regenerative tion. The role of the Authority is to ‘spearhead and be
tissue (blood and bone marrow) and non-regenerative accountable for a new world’s best practice national
tissue (cord blood, kidneys, liver (lobe/s), lungs (lobe/s), approach and system to achieve a significant and lasting
femoral heads). The implications of consent are different increase in the number of life-saving and life-transforming
for each type of requested tissue. For example, the collec- transplants for Australians’. 1
tion of bone marrow, retrieval of a kidney, the lobe of a
liver or lung are invasive procedures that could potentially The Authority was established in 2009 under the Austra-
14
risk the health and wellbeing of the donor. In contrast, lian Organ and Tissue Donation and Transplantation Author-
donation of a femoral head could be the end-product ity Act 2008 as an independent statutory authority within
of a total hip replacement, where the bone is otherwise the Australian Government Health and Ageing portfolio.
discarded. Similarly, cord blood from the umbilical The DonateLife Network, under the Authority, include
cord is discarded if not retrieved immediately after birth. ‘DonateLife’ agencies and hospital-based staff across Aus-
tralia dedicated to organ and tissue donation. DonateLife
After cardiac death, many people can be donors for eyes,
heart valves and cardiac tissue, long bones, pelvis, tendons, agencies were re-formed and re-named as a nationally
ligaments and skin. On occasion, and in appropriate and integrated network to manage and deliver the organ
controlled situations, some people could also be donors donation process according to national protocols and
of kidneys, liver and lungs. It is after brain death that the systems and in collaboration with their hospital-based
1
‘traditional’ organs of the heart, lungs, liver, kidneys, pan- colleagues. Legislation in New Zealand is national, with
creas and tissues can potentially be retrieved. Organ Donation New Zealand coordinating all organ and
tissue retrieval from deceased donors. 4
ORGAN DONATION AND TRANSPLANT REGULATION AND MANAGEMENT
NETWORKS IN AUSTRALASIA
In Australia, quality processes involved in organ and
The donation and transplantation process in Australia is tissue retrieval and transplant are governed by the Thera-
15
a nationally coordinated process in the healthcare system, peutics Goods Administration. In New Zealand there
a unique arrangement given the disparity between state is currently an unregulated market for medical devices