Waste not, want not: new organ donation policy could save lives

By Aric Bendorf, University of Sydney and Ainsley Newson, University of Sydney

Australia has never had a great deceased organ donor rate – and it fell last year. But proposed guidelines from the National Health and Medical Research Council (NHMRC) could change how donor organs are obtained and allocated for the better.

DonateLife Australia, the government body responsible for organ donation and transplantation, has just announced there were 16.1 deceased organ donors per million people in Australia in 2014. This represents a 5% decline from 2013 and maintains Australia’s deceased organ donor rate in the bottom half of OECD countries. It’s important to note, though, that the 2013 rate was the highest ever recorded.

More people in this country die waiting for organ transplants than in many other developed countries, but it’s not all bad news: Australia has a long and successful history in organ transplantation.

Outcomes following organ transplantation are world leading – more than 90% of patients who receive a kidney, heart, heart-lung or liver transplant are alive a year later. And more than 90% of people who receive a transplant have normal function of their new organ. The number of organs retrieved from each deceased donor is also higher than in many countries.

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Asylum seeker’s ‘brain death’ shows failure of care and of democracy

By Ian Kerridge, University of Sydney and David Isaacs, University of Sydney

The news that Hamid Kehazaei, a 24-year-old Iranian asylum seeker detained on Manus Island, has been diagnosed as brain dead following his transfer to the Mater Hospital in Brisbane is a tragedy. That it is a tragedy for this young man and his family is unquestionable – but the extent of this tragedy may be much more pervasive than we realise.

If the emerging details of his case are correct, Kehazaei developed septicaemia as a complication of cellulitis (skin and soft-tissue infection) arising from a cut in his foot. This, in itself, is disturbing.

Severe infection can result in brain death – either from infection of the brain itself (meningitis, encephalitis or brain abscess), or from brain injury due to a lack of oxygen resulting from cardiac arrest (as appears to be the case here), or from reduced blood supply to the brain. Yet it is very uncommon, especially in a young, previously healthy man.

Such a case could occur in Australia and has been described in 2012 in young Indigenous adults in Central Australia. Nevertheless, severe sepsis resulting from a foot infection is preventable. And a case like this occurring in an Australian national would raise serious questions about the appropriateness of the antibiotics used and the timeliness of care.

Most cases of brain death result from traumatic brain injury, stroke or lack of oxygen to the brain following asphyxia, near-drowning, or prolonged cardiopulmonary resuscitation.

What happened to Hamid Kehazaei raises concerns about the adequacy of care provided to him during initial treatment, including wound care and antibiotics, and how soon he was transferred to expert medical care, first to Port Moresby and subsequently to Brisbane.

If this young man became ill and had his brain die while seeking asylum in Australia and while in our care, then we must examine the details of his case and ask ourselves not only whether it was preventable but whether our policies and processes actually contributed to his death.

But how can we even begin to ask these types of questions when we know so little about the circumstances in which he became ill, and his subsequent care?

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Epidemic ethics: four lessons from the current Ebola outbreak

By Ian Kerridge, University of Sydney and Lyn Gilbert, University of Sydney

The extent of the current Ebola virus outbreak in West Africa has belatedly focused the attention of non-governmental organisations, local and Western governments, and international media. What we haven’t caught up with though, is the extent to which these outbreaks and their devastating effects are predictable and preventable.

The spread of Ebola virus occurs because health infrastructure in the region is fragmented, under-resourced, or non-existent. And the therapeutic response to the illness is constrained by failure of markets to drive drug and vaccine development that would help the world’s poorest people.

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