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Human Tissue Amendment Bill 2020

'The Greens support this necessary bill, but it will not really change anything much. What would make a welcome change would be for the state government to increase the number of eligible donors

Dr READ (Brunswick) Before I start, I just want to acknowledge the useful and experienced contribution from the member for Footscray.

The Human Tissue Amendment Bill 2020 sets out the consent process for procedures to be performed on donor patients, who would usually be in intensive care, which benefit the organ recipient but not the donor. These are done before the donor’s heart stops. Before organ donation the donor patient must be given certain medicines, have tubes inserted into arteries and veins and have various blood tests such as tissue typing and other tests done. The current Human Tissue Act 1982 does not clarify sufficiently how consent should be obtained for these procedures which do not benefit the donor.

Under the process in this bill the designated officer of the hospital gives consent after obtaining consent from a medical treatment decision-maker, who would usually be the donor’s next of kin, if they can be located, and, again, after two other doctors have certified that the donor patient will die when artificial breathing or circulation has stopped. Just on that point, the house amendment is a sensible adjustment to that provision.

Last year in Australia 548 people donated organs after dying in Australian hospitals. Their organs went to over 1400 people, because as the member for Footscray pointed out, the organs from one donor are often sent to several people who need them. Just over half of the donated organs were kidneys; most of the remainder were livers, lungs and hearts in descending order. Other organs and tissues are also donated.

Transplant outcomes have now improved considerably, and transplantation is now an accepted treatment option for a number of organ failure conditions. But it is greatly limited by the availability of donors. Less than 2 per cent of people dying in our hospitals are suitable donors. Last year 63 per cent of Victorian families asked agreed to their dead relatives’ organs being donated. That is roughly similar to the national rate, but South Australia is considerably better at 74 per cent of those asked agreeing to organ donation. South Australia is the only state still asking people to register as organ donors when they renew their drivers licence. Victoria stopped that some years ago, and now only 20 per cent of Victorians are registered donors compared to 70 per cent in South Australia. I recommend that the Minister for Health talk to the Minister for Public Transport and Minister for Roads and Road Safety about reintroducing this system of asking people to become organ donors when they renew their drivers licence and/or at other important life events, such as doing VCE.

According to DonateLife about 90 per cent of families will consent to donation if their dead relative was registered as an organ donor compared to around 50 per cent if they are not. Perhaps that is something the member for Footscray could pursue.

The other thing to consider is what else we could do to increase the supply of donors—that is ethical, that is. Every year some people are deemed unsuitable to donate their organs because they have hepatitis C or may have been exposed to hepatitis C because they have injected drugs at some stage. This was estimated to be around 10 per cent of potential donors in 2015 in Australia in a paper published earlier this year in scientific reports by Scott, Doyle and others. International experience shows that this need not be a barrier because hepatitis C is now readily treatable. The barrier of hepatitis C or potential hepatitis C could easily be removed, allowing an immediate increase in the organ supply. This is not happening on any scale in Australia because the Pharmaceutical Benefits Scheme will not supply the necessary few weeks of hepatitis C treatment drugs for transplant recipients. Victoria should approach the federal health department and resolve this relatively small barrier to increasing the supply of donors.

Finally, as we heard earlier, there is an argument that all of us should be assumed to be organ donors unless we or our relatives when we die opt out. Opt-out organ donation has been widely discussed and is actively promoted by Mr Allan Turner, whose daughter Zaidee’s organs benefited seven others. This was adopted in the UK in May this year and already applies in a number of countries. Personally I find it a persuasive argument. Families can still say no if they wish.

In practice this does not really change what happens a great deal; it just means that the conversation begins from a starting point that everyone is a potential organ donor. However, I think it is very important that we heed the concerns raised by health workers and others that any suggestion of compulsion would undermine trust in the health system, particularly among those from some of the diverse cultures who rely upon our health system. Like vaccination, trust is important, and compulsion risks eroding the social licence. Organ donation requires a spirit of altruism, and that could be undermined or damaged by an opt-out system. We need to consider this, but we should not necessarily be paralysed by this as a potential barrier.

Our community has changed over the past few years and opt-out donation may be more acceptable than it would have been 10 or 20 years ago. Perhaps we should do some research and find out. The Greens support this necessary bill, but it will not really change anything much. What would make a welcome change would be for the state government to increase the number of eligible donors by arranging hepatitis C treatment for transplant patients and by linking driver licensing to organ donation registration and then, if we still cannot get our consent rate up high enough, to explore opt-out organ donation.

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Dr Tim Read
Greens MP for Brunswick
29 October 2020



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