Our focus on finding more organ transplant donors is in intensive care.
Last year, 186 people had life-saving organ transplants from deceased donors in New Zealand – most commonly receiving a new kidney but also livers, lungs, hearts and even a few pancreases. Many more patients had their lives and health improved by transplants of heart valves, corneas and skin. Despite the pandemic, with its various alert levels and lockdowns, those surgeries kept happening.
"I don't think we lost any opportunities because of Covid," says Dr Joanne Ritchie, clinical lead at Organ Donation NZ, "although it certainly added a few logistical issues."
Since 2013, the number of transplants in this country has doubled, but there are still more than 500 people on the waiting list. Inevitably, some will die and others will continue to lead lives severely restricted by illness.
In an attempt to tackle a shortage of donors, several countries have introduced an opt-out system. In England, a law change came into effect in May 2020, so that all eligible adults are considered to have agreed to be an organ donor when they die unless they have recorded a decision not to.
Presumed consent isn't something being promoted in New Zealand, however. Dr Ritchie says this is partly because it hasn't always been shown to improve rates and in some places may have been counterproductive, causing a backlash against organ donation.
"When you talk to the services overseas, they all say the thing that has improved their rates is teams in the intensive care units [ICUs] recognising the potential and referring to a donation agency," she says. "So, our big drive is working with the ICUs, ensuring every opportunity is picked up and families are given the chance to discuss donation."
Organ donation is possible only when a patient is on a ventilator in an ICU. In this country, only about 1 per cent of deaths happen in a way that is compatible with the procedure. Last year, of 64 deceased donors, 56 suffered brain death and the rest circulatory death (the heart stopped).
Theoretically, there is the potential to increase rates by transferring patients from wards or emergency departments, so a death is able to take place on a ventilator, making them eligible to donate.
"But we've never had the resources to do that on the same scale as some other countries, such as Australia," Dr Ritchie says. "Although we have the deaths, we don't necessarily have them in the ICUs."
The 2019 eruption on Whakaari/White Island increased our awareness of the importance of tissue donation. The National Burn Service requested 120 sq m of skin from the US, where there are more tissue banks, to treat the large number of patients with severe burns.
Skin can be taken from deceased donors of any age, eye tissue can be donated up to the age of 85 and heart valves up to 60.
"Anyone who dies could potentially be a tissue donor," Dr Ritchie says. "They don't have to die in an ICU. It is dependent on things such as having a technician who is able to retrieve the tissue, but there is definitely much greater potential for that sort of donation in New Zealand."
Whenever you renew your driver licence, you can tick a box to say you wish to be a donor. But the Human Tissue Act 2008 also requires the informed consent of your next of kin, and that means some tough conversations take place in ICUs.
"Those conversations are usually had by one of the intensive-care team," says Dr Ritchie. "One problem is we might have a unit that has a donation only every few years and the person who's there at the time has had very little or no experience of organ donation, so that can be difficult for them but also very rewarding."
In this country, 24 ICUs are able to facilitate donation after brain death and just nine after circulatory death. "That's where we'll see growth in our donation numbers and where we're doing a lot of work at the moment."
Dr Ritchie's main message continues to be that people should discuss their wishes about donation with their close family.
"You may have 'Donor' on your driver licence, but you also need to tell your next of kin it's what you would like if the worst happens."