The Government’s proposed legislation for an opt-out system of organ donation is “unlikely” to make any difference to organ donation rates in Ireland, according to a leading intensivist in the field.
Dr Alan Gaffney, Consultant in Intensive Care Medicine and Clinical Lead in Organ Donation at RCSI Hospitals, was speaking to the Medical Independent in advance of the recent launch of a new pilot study of organ donation practice in six intensive care units (ICUs) over a three-month period.
The Potential Donor Audit Development Project Report, published by the National Office of Clinical Audit (NOCA), was commissioned by HSE Organ Donation and Transplant Ireland.
Overall, the report identified a small number of cases where best practice organ donation processes were not followed and which may otherwise have resulted in donation episodes. It recommended deployment of the audit nationally to drive continuous improvement.
According to the audit, 37 per cent of families of eligible organ donors were approached with specialist organ donation personnel present, and 53 per cent of families were approached at the recommended time.
The report noted that Hospital Group organ donation personnel are not a 24/7 service. By comparison, the NHS has specialist nurses in organ donation in most hospitals. The involvement of specialist staff at an early stage is associated with higher rates of family assent.
Dr Gaffney, Clinical Lead of the potential donor audit development project, noted there are “very specific” circumstances in which a person has the potential to be an organ donor following death.
“And that leads me on to the next point, which is that the Government is hoping to bring through the Human Tissue Bill this year, and we as an intensive care community feel that it is unlikely that the Human Tissue Bill will make any difference to the organ donation rate in Ireland.
“In fact, legislation for opt-out donation has never made a difference to organ donation rates anywhere in the world. What makes the difference is how well we recognise organ donors within the hospital, how well we approach families, how well we do brainstem testing… they are the things that will make a difference to organ donation rates.”
Commenting on the NOCA report, Director of HSE ODTI Prof Jim Egan stated: “The findings of the report demonstrate that a PDA should be deployed nationally as soon as possible…. This will be a vitally important mechanism to inform future development of organ donation and transplant services. To this end, ODTI has secured funding to continue the PDA in the six participating ICUs until the end of the year. Furthermore, we have made a submission under the national service plan for 2024 for funding to roll-out the PDA to all hospitals with ICUs or emergency departments.
Prof Egan said a national PDA “will be key to ensuring our national service harnesses benefits from pending legislative change, advances in medical and surgical practice in specialities aligned with organ donation and transplant, and technological advances in organ care”.
A spokesperson for the Irish Kidney Association (IKA), which has been calling for an annual clinical audit of organ donation practices for many years, commented: “Whilst the commitment to an annual potential donor audit is commendable and the work of NOCA is excellent, the Irish Kidney Association would like to see provision for the audit included in the Human Tissue Bill, which is expected to be transposed into law later this year. In this way it would put it on a statutory footing and ensure that its delivery is not at risk of the vagaries of changing budgets or possible future recruitment freezes.”
The IKA is also advocating for the inclusion of an opt-in register to run alongside the opt-out register proposed in the Bill, and greater public education around organ donation.
It added that the presence of specialist organ donation staff during the approach to families was vitally important.