Organ donors: A matter of life and death

By JULIE MIDDLETON

The Maori patient had an organ transplant but wasn't feeling too happy about his new parts. It wasn't anything physical, more a sort of vague psychological unease, and he told a Maori hospital staffer that he didn't think he was going to survive.

The staffer realised that he hadn't made the mental shift to recovery by farewelling the old organs and welcoming the new. She encouraged him to do that, and two days later he was discharged, much happier and on track for a healthy new life.

These are the sorts of stories that were shared yesterday when the Ministry of Health held its latest nationwide open-invitation consultation on the laws governing the use and storage of human tissue for organ transplants, research, teaching and the like.

About 40 people, most of them medical types but maybe half a dozen interested members of the public, gathered at the Carlton Hotel in Auckland for a fascinating day-long talkfest.

Ministry staff have been going around the country asking people to comment on five options on managing the organ donation system: the regime at present, where you can have "donor" printed on your driver's licence; a requirement that any clearly recorded wishes be followed, and a variation under which people would be required to state their wishes; a system where organ donation would be discussed with all patients entering hospital; and presumed consent - that you are a donor unless you opt out.

The option of presumed consent was universally unpopular among those at the Auckland meeting, as it has been elsewhere. There was a feeling that New Zealanders would not accept it although in other countries where it exists, such as France, it has raised the donor rate.

(France donates at the the rate of 17 per million people; the New Zealand figure is 9.6.)

It was the presumed consent option that prompted retired couple Beverley and Murray Blyth to travel from Whangaparaoa. "We heard about it on the news and were horrified," said Mrs Blyth.

But she agreed to suggestions that education was needed to raise awareness - ticking a box when getting a licence was not seen as particularly informed consent.

Ideas flowed: why not attach a record of donor wishes to their unique National Health Index number? Why not link into the Australian donor registry system? Why don't we have people make a positive statement on donation during life that their family can't overrule?

Meetings have already been held in Wellington and Rotorua. Another is planned for Christchurch on Monday.

Answers wanted

The use of human tissue: some of the questions the Ministry of Health is asking:

* Do you think the new legislative framework should have informed consent as its foremost principle?

* If so, should a secondary principle recognise that in certain circumstances, the public good associated with the use of tissue will outweigh informed consent, provided that safeguards are in place?

* Should the new legislative framework make it clear that the donation of organs or tissue from people who have died should only be on the basis that the organs or tissue are an "unconditional gift"? (as in you cannot state what sort of person to whom your organs can go)?

* Do you agree that it is not appropriate for the body of a deceased person to be used for anatomical examination if the view of the deceased person about this use is not known?

* Do you think if both parties wish to, donor families and recipients should be able to meet? If so, what types of support should be offered for this to happen?

* Should both parents have an equal say in what happens to the body of their deceased child, or are there circumstances where the mother's wishes should prevail?

Source: Ministry of Health discussion document.