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Organ donation – should Australia adopt an opt-out system?

16 Aug 2017



The statistics paint a stark picture. More than 12,000 Australians suffer each year while they are on transplant waiting lists or dialysis. Six Australians will die in August alone while waiting for an organ transplant, a grim reminder of the limitations of the healthcare system in the face of overwhelming demand and scarce supply.

But is the organ donation system merely indicative of a failure by the Government to enact smart legislation that goes some way to overcoming societal apathy towards registering as an organ donor?  

It has become evident that Australia’s current opt-In organ procurement legislation has failed to correct the disparity between the number of people on organ transplant waiting lists and the number of organs available for transplantation.  A number of factors have been identified which potentiate this ever-widening gap.  Primarily, the aforementioned societal unwillingness to registering as an organ donor, followed by potential donors’ families denying consent when donation is requested, and the reluctance of health care professionals to request that the deceased patient’s organs be donated.

Australia is ranked 20 in the world for organ donation. We are behind countries such as Croatia, Spain, Portugal and Italy.  Recent international studies have demonstrated that implementation of an Opt Out system of organ procurement would increase donation rates by 50 per cent.

Spain has been most successful in implementing “soft” opt-out legislation there, sustaining the highest rate of organ donation in the world for the past two decades. Implementation of the Spanish model opt-out legislation in Australia could result in an additional 1,400 Australians receiving a transplant every year. Think about the impact of that on the healthcare system in terms of primary, hospital and allied health care, and the associated effect on patient flow.

Notwithstanding the advantages of an opt-out system for those individuals on organ transplant lists, nevertheless implementation of an opt-out system in Australia requires examination of several ethical issues. Whilst Australian law states that there is no property in a dead body, the potential for a negative impact upon individual autonomy must be considered. 

Despite proponents of presumed consent suggesting that implementation of an opt-out system could improve individual autonomy, a number of authors are sceptical of this claim.  However, when weighing limits of personal autonomy against the concept of benefits to society in terms of giving back to the community, under a communitarian-based approach, the number of lives that could be saved as a result of the enacting opt-out legislation could be preferable to society.

If implementation of a national “soft” opt-out organ donation legislation is proposed in Australia, enactment of this type of legislation must be prefaced by comprehensive publicity and education programs, focusing on both the general public and health care professionals. In conjunction with these amendments to legislation, Australia should adopt an individual hospital-based approach to organ donation as described under the “Spanish model”.

Australia must act now to implement these changes. People will continue to die until the disparity between organs required and those available for organ transplantation is rectified.

 Views expressed in the above Opinion piece are those of the author and do not reflect official policy of the AMA.

David Tarrant is a lawyer and a registered nurse. He completed his Honours thesis on organ donation, which was published in the NSW Operating Theatre Nurses Association Journal, and has also drafted papers on related issues (in collaboration with his colleagues at Carroll & O’Dea Lawyers). Prior to embarking on his legal career, David worked in hospitals in Tamworth, Sydney and London. Following completion of his Graduate Diploma in Clinical Practice, he was awarded the Anne Carrodus Memorial Prize for excellence in clinical practice.



Published: 16 Aug 2017