Right: A "donor card" carried by many UK citizens, expressing their wish that their organs be donated after their deaths.Further implications
Australia's organ donation rate is relatively low by world standards. The Rudd Government has recently directed $136 million toward improving the nation's organ donation rate. In such a context it may appear regrettable that critics such as Professor Tibballs have publicly raised doubts about the rigorousness of the procedures applied when determining brain death and harvesting organs from Australian donors.However, Australia's rate of organ transplantation would appear to imply that many in the community are already either ill-informed about or frankly sceptical of the procedures that actually apply when organs are taken from donors.
Surveys have repeatedly indicated that there is an apparently high rate of acceptance of organ donation among the Australian community which is not translating into practical support for transplantation in terms of actual donations. It would appear that for whatever reason the altruistic urge to assist those in need of replacement organs often does not survive when the real-life opportunity to donate presents itself.
There is a range of possible reasons for this. One of this would appear to be confronting the concerns that some in the community have about the safeguards surrounding the certification of death and the donation of organs.
Professor Tibballs has indicated that there may be grounds for strengthening the criteria used to determine whether brain death has occurred. He has suggested that some of the interventions used to ensure that organs can be harvested after cardiac death may not be in the best interests of the patient. He has further suggested many relatives and donors are not fully informed of the procedures to be applied when organs are taken from a donor.
One option which has been proposed to help resolve these issues is to have more than one form of donor agreement to organ donation.
It has been suggested that some potential donors might agree to donate their organs only under the most rigorous standards of irreversible brain death outlined by Professor Tibballs and others such as Professor Tonti-Filippini.
Others might agree to donate organs under a less rigorous standard, which would allow pre-death interventions (such as the administration of anti-coagulants) and the use of brain stem death as a standard (rather than total brain death and the cessation of circulation to the brain) as the point at which death can be certified.
Such a flexible approach to gaining donor agreement would involve a dramatic increase in public education about the nature of death and the various manners in which it might be determined.
This two-level approach would, theoretically, have the advantage of giving donors complete control of the circumstances under which their organs were harvested. It is conceivable that this might help to increase the rate of organ donation in this country. It is, however, dependent on a dramatic increase in the level of public knowledge of the issue.
This approach also presupposes that potential donors would have indicated their wishes regarding organ donation prior to suffering a life-threatening injury or disease. Decisions of this complexity could only realistically be made in advance of the situation where they were required to be acted upon.