For nearly thirty years, people suffering from kidney failure have had two options for life sustaining treatment - either have dialysis (a process that removes waste products and fluids that healthy kidneys remove from the blood stream.) or have a kidney transplant.
There are two sources of kidneys.
- Deceased (cadaveric) donors - from a previously well person, who has died in an intensive care unit in hospital, having suffered severe and irreversible brain damage.
- Living donors - from a healthy person with two healthy kidneys. Most people can live a normal healthy life with one kidney.
Only one kidney is transplanted into each recipient. Therefore a deceased donor may be a donor for two kidney recipients. In New Zealand 300 people on average are waiting to have a kidney transplant each month. About 50 of these patients live in Canterbury, Otago and Southland. On average each person will wait about three years for a transplant because in any one year there are not enough kidneys available to transplant. In 2003 74 kidneys were transplanted in New Zealand.
Patients who receive a transplant that works well (80 - 90% will be working well a year after transplantation) almost always find life more enjoyable. Kate, who had a transplant after three and a half years on dialysis, is feeling better and has a great sense of freedom. "It's been such a relief. When you have to have dialysis, everything seems to revolve around that process which happens in three eight-hour sessions a week", she says. "Now I've got my life back again. I don't have to plan everything around dialysis. It makes me feel quite humble when people offer something like this which makes such a huge difference to someone else's life."
There are many people who have benefited from the generous decision of families who have said yes to organ donation. Transplant surgeon, Professor Justin Roake, hopes that New Zealand can significantly improve its donor numbers. At present about 12 people in every million of population become donors, but in some countries like Spain the figure is more than 30 donors per million. Audits are currently being done to identify reasons for a low donor rate in New Zealand.
"We have a driver's licence system where people indicate on their licence whether they are prepared to be an organ donor after a fatal accident or stroke, that is if they are declared "brain-dead" while being cared for in an intensive care unit", he says. "But the time when the relatives are asked about organ donation is an emotional time, and for many it is a subject that has not been discussed in the past."
"This is why all those involved in organ transplants stress that it is most important for people to discuss with their immediate relatives their wish to be an organ donor. This often means any objections from relatives are sorted out beforehand."
Professor Roake firmly believes that more could be done to reduce the waiting time for the 300 people who, each month, are ready to have a kidney transplant. While we do 30 transplants a year in Christchurch, only 16 or so of these are transplants from a deceased donor, and we have a waiting list which isn't dropping, as each year new patients are considered suitable for transplantation. We have to work more on educating the public about the huge difference a healthy kidney can make to someone's quality of life".
Who can be an organ donor?
A previously well person who has suffered severe and irreversible brain damage ( usually from an accident or brain haemorrhage) and admitted to an intensive care unit and after careful assessment is considered to be "brain-dead". People up to the age of 80 will be considered for organ donation and up to 85 years for corneal donation. However, the age and medical condition at the time of death will determine which organs and tissues are suitable for transplantation.
How do people indicate they would want to be a donor?
Individuals can indicate their wish to be an organ donor on their driver's licence. However the most important step is to discuss organ donation with family or your power -of attorney to let them know your wishes.
If the next of kin disagrees with a decision to donate can they prevent the donation taking place?
In practice, medical staff will not remove organs unless the family agrees and permission is granted.
How many people would benefit from one donor?
Two patients could receive a kidney each and up to seven other people could receive other organs or tissues for transplant from one donor.
What do religious groups think about organ donation?
Most religious groups generally support the principles of organ donation. If any individual has concerns about his or her religion's position, then a member of the clergy could be consulted.
Should a decision to donate organs be included in a will?
No. Most organs and tissues must be retrieved before a will can be read.
Can organs be bought and sold?
No. In New Zealand organ donation is considered a gift and the buying and selling of organs is illegal.
Does the decision to become an organ donor interfere with a person's health care?
No. Donors receive the same high quality care that non-donors receive. Medical personnel must follow strict guidelines before death can be pronounced and the donor's organs and tissues can be removed.
What is brain-death?
(This definition is adapted from information provided by ACCORD - Australian Co-ordinating Committee for Organ Registries and Donation)
In most cases it is easy to tell when someone has died; they do not breathe or move, nor have a pulse and their skin changes colour because blood is no longer circulating. This applies whatever the cause of death. When someone is dead due to brain death, the brain stops functioning and will never function again. It means there is no supply of blood or oxygen to their brain, the brain cells die and cannot grow again or be replaced. However, the person will be in an intensive care unit connected to a mechanical ventilator (breathing machine) which pumps oxygen into the lungs making the chest rise and fall. Some of the illnesses that can result in brain death are, head injury, bleeding into the brain, brain tumour and brain infection.