Spectrum / Issue 20
Transplantation: Challenges for the New Government Recent trends in organ donation send out worrying signals that need to be addressed by our new Government. 2010 saw the highest fall in organ donation on record in Ireland. Donations fell by 35% with only 58 deceased donors providing organs for 243 transplant recipients (inlcuing heart, lung, liver, kidney and pancreas trasnplants). Major gaps and weaknesses remain in the donation/transplantation policy framework in Ireland, which were not addressed by the last government. These include: • The fact that Ireland is one of the last countries in Europe not to have a legal framework underpinning donation and transplantation. The Human Tissue Bill, 2009 was not enacted despite the requests by NGO’s, including the Irish Donor Network, for its prioritisation. • The need for at least 12 organ donor co-ordinators to be based in the main acute hospitals is increasingly regarded as being crucial to providing support to donor families and would help co-ordinate the transplant process. • The pressing need for a national organ donor registry to be established where potential donors and potentailly next of kin could sign up online. This would help bring organ donation into the 21st century. The HSE has resated its committment to establish a Transplant and Organ Donation Office in Ireland. This is one of the requirements arising from an EU Directive which requires a ‘competent authority’ to be establsihed by June 2012. Despite its delay (it was originally planned to be up and running by December 2010), it is welcome news that the Office will be establsihed and that Professor Jim Egan of the Mater Hospital has recently been appointed lead clinician for this new office. These positive developments now need to be matched with giving the Office the necessary resources and status to undertake its work effectively. The Government has also indicated in the new programme for government that it will introduce presumed consent, i.e. it will be presumed that all potential donors have opted in to donating their organs, unless they or their next of kin have indicated otherwise. It is unclear how this would opperate in practice and there are ceratinly views both for and against this meausure. However, it should be noted that presumed consent has had a positive impact on donation rates in other countries, such as Spain. It is important that this measure is considered as part of an overall framework, rather than being a panacea that will solve the donation and transplant challenges in Ireland. There are particular challenges for all those needing a lung transplant in Ireland, including CF patients in need a double lung transplant. The HSE have recently given the go ahead to the Mater to appoint the first dedicated lung transplant surgeon in Ireland. This is a really important development, but likewise it will require concommitant improvements in our overall policy framework, such as appointing organ co-ordinators in acute hospitals if the benefit of this appointment is to be fully realised. In 2010 there were 7 CF double lung transplants on patients from the Republic of Ireland undertaken in Freeman’s Hospital, Newcastle and 3 in the Mater Hospital, Dublin. However, there are over 30 people currently on the waiting list and at least 20 other non-CF patients who need a lung transplant. This marks 2010 as being a more sucessful year for lung transplants for people with CF than previous years. However, CFAI contends that this improvement can only be sustained if a proper policy framework is put in place.
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