Australia: 'High risk' organs for elderly and unwell patients: new guidelines

[Clark]

http://www.smh.com.au/national/health/high-risk-organs-for-elderly-and-unwell-patients-new-guidelines-20150119-12t7i6.html

'High risk' organs for elderly and unwell patients: new guidelines
Amy Corderoy

More elderly or unwell people could be allowed access to "high risk" organs that would not be considered suitable for other people under draft organ donation guidelines released for public consultation.

The guidelines also for the first time open the door to deceased donors having some say in where their organ goes. However, they warn equal access will always trump donor wishes, and it could only go ahead in the most exceptional circumstances, such as when a person was already planning on being a living donor for a loved one before they died.

The draft Ethical guidelines for organ transplantation from deceased donors aims to tackle some of the most difficult dilemmas facing doctors working in the organ transplantation, where demand far outstrips supply. It is thought each week at least one Australian dies waiting for an organ that could save them. They were developed by the National Health and Medical Research Council, and will be open for public consultation until March 6.

Ian Olver, the chairman of the guidelines committee, said given that about 1500 people are waiting for an organ at any one time, it was important the nation had fair and transparent guidelines about how they are allocated.

However, medical advancements meant that doctors were now figuring out ways to use so called "higher risk" organs that in the past would not have been considered good enough quality – opening up new opportunities as well as ethical dilemmas.

"It's really evolving, and as transplants are becoming more successful, and of course we still have this tremendous demand for transplants, there is no doubt that some people would benefit from an organ that in the early days would have been considered less than ideal because of the condition of the donor," he said.

"It has become clear that less-than-perfect organs can benefit people who are going to die without a transplant. That adds a degree of complexity about how we allocate those less-than-perfect organs".

The guidelines, which illustrate the principles with theoretical case studies, give an example of a 25-year-old woman and 72-year-old man who are both waiting for a kidney. When a higher risk kidney becomes available, the guidelines suggest it might be given to the man because he is less likely to need a new transplant later, and his likelihood of death while waiting for another organ is greater.

Professor Olver said the committee wanted to leave room for complexity.

"You can make all these general principles, for example that skin colour shouldn't matter, until you come to complete an organ transplant like a face transplant, and then obviously skin colour does matter," he said.

The chief executive of the medical research council, Warwick Anderson, said there was no "right way" to decide how to allocate organs.

"Once finalised, these guidelines will provide an overarching framework to help decision-makers with the tough calls in ethically robust ways," he said.

The guidelines say people should not be discriminated against on the basis of past behaviour or any medically irrelevant grounds. However, if doctors consider they might in future behave in a way that could jeopardise the success of the transplant, this could be considered.

For example, someone who had a history of use of a drug such as heroin or ice and needed a liver transplant would not be denied the transplant on the basis of their previous use, but would be denied it if tests showed they were still using. The guidelines also state that a person with a serious mental illness such as bipolar disorder should be assessed by doctors or social workers as to whether they would be able to adhere to ongoing treatment post-transplantation, either by themselves or with support.