The implementation of a recent national reform in Australia has resulted in a dramatic increase in organ donation and transplantation. Prior to 2009 there were approximately 200 deceased donors per year (average of 10 donors per million population, dpmp), with this having increased to 354 deceased donors in 2012 (15.6 dpmp). Key elements of the reform have included the establishment of the Australian Organ and Tissue Authority, employment of dedicated donation specialist staff in hospitals, and a community engagement and awareness program.
Key areas of focus in hospitals include optimisation of all of the steps in the donation process, such as identification of potential donors (1-2% of deaths), donor physiological management, supporting the family to make an informed choice about donation, and organ retrieval.
There have been increases in both pathways to donation, with modest increases in donation after brain death and a marked uptake of donation after cardio-circulatory death (DCD). Unlike has occurred in some countries, implementation of DCD in Australia does not appear to be diverting patients from the brain death pathway.
Medical suitability criteria also continue to broaden over time due to improving transplantation medical technology and resultant better outcomes, and a persisting shortage of organs relative to the number of people who would benefit from a transplant.
Ongoing work is likely to result in further increases in rates of donation and transplantation, with most future potential likely to occur through improved rates of consent (currently less than 60%) and further uptake of DCD. Challenges include working to achieve this possible growth (national target of 25 dmp by 2018), and resourcing and planning for the associated downstream impact including on tissue typing, surgical retrieval and transplantation services.