Dr Graeme A Pollock   MPH  PhDDirectorLions Eye Donation Service Melbourne

DONATEARAINBOW

Largest deceased donor sector‐ greatest number of donors‐ greatest number of transplants‐ greatest number of transplants required

Largest deceased donor sector‐ greatest number of donors‐ greatest number of transplants‐ greatest number of transplants required

Since 1991‐ Almost 4,000 donors‐Over 10,000 transplants‐‐Meets current Victorian case‐load‐Receives no direct government funding (fee‐per‐service basis)

Since 1991‐ Almost 4,000 donors‐Over 10,000 transplants‐‐Meets current Victorian case‐load‐Receives no direct government funding (fee‐per‐service basis)

Graeme Pollock• Donor Coordinator since 1991

– Most experienced in Australia

– Over 500 consents & over 1000 donors

• Medical Advisory Board Eye Bank Association of America– Oversees >70,000 corneal transplants per annum

• Associate Editor International Journal of Eye Banking

• Interim Chair Global Alliance of Eye Bank Associations– Responsible for > 200,000 corneal transplants per annum

DONATION

Public Health Aspects

The type of legislative framework a country adopts does not necessarily correlate with the performance of its organ, eye and tissue donation programs

The type of legislative framework a country adopts does not necessarily correlate with the performance of its organ, eye and tissue donation programs

The type of organisational structure a country adopts does not necessarily correlate with the performance across alldonation sectors

The type of organisational structure a country adopts does not necessarily correlate with the performance across alldonation sectors

• Staff• Training• Facilities• Location

• Staff• Training• Facilities• Recipient numbers

• Cultural• Social Capital• Legislative

• Baseline Medical Suitability

• Access

Availability of Potential Donors

Underlying Public Support

Donation Services 

Infrastructure

Transplantation Infrastructure

DONATION

“Presumed” Consent

• Donation needs to be undertaken in a cooperative environment

• Risk– Medical and Lifestyle Interview with person that best knew the donor

• Medical assessment on whether to proceed with donation

10. Male: to the best of your knowledge, has he been sexually active with another male in the last 12 months? Female: within the last 12 months, has she been sexually active with a male who has been sexually active with another male?

10. Male: to the best of your knowledge, has he been sexually active with another male in the last 12 months? Female: within the last 12 months, has she been sexually active with a male who has been sexually active with another male?

12. Has he/she been sexually active in the past 12 months with any person known or suspected to be infected with HIV, Hepatitis B or Hepatitis C?

12. Has he/she been sexually active in the past 12 months with any person known or suspected to be infected with HIV, Hepatitis B or Hepatitis C?

(You) may formulate legislation that specifies the circumstancesin which a donation is consented BUT you can’t formulate legislation that dictates that a donation must be accepted

(You) may formulate legislation that specifies the circumstancesin which a donation is consented BUT you can’t formulate legislation that dictates that a donation must be accepted

Increasing Donation

• Amend the Coroner’s Act to explicitly support organ and tissue donation– Delays compromising donation

• Clarify the Acts relating to Privacy of medical information– Need to have access to make a medical assessment of potential to donate

Conditions of Participation Rule

• U.S. Department of Health 1998

• Requires Hospitals to report all deaths to a Donation Service (OPO, Tissue Bank, Eye Bank) in a timelymanner

• Small increase in organ donors, huge increase in tissue donors and eye donors

• Staff• Training• Facilities• Location

Donation Services 

Infrastructure

Victoria

• 25,000 deaths/yr

• 17,500 reported

• 336 per week

• 48 per day

• 2 referrals every hour, every day

Victoria

• 25,000 deaths/yr

• 17,500 reported

• 336 per week

• 48 per day

• 2 referrals every hour, every day

Conditions of Participation Rule

• Requires a very large expansion of donation services and support infrastructure

• Can result in many, many donors!!

BUT it is INEFFICIENT & COSTLY

Lions Eye Donation Service

• 5% of 17,500 reported

• 875 donors

• Donation Service 4 times as large as present

• 1,575 transplants

Lions Eye Donation Service

• 5% of 17,500 reported

• 875 donors

• Donation Service 4 times as large as present

• 1,575 transplants

Conditions of Participation Rule

• Requires a very large expansion of donation services and support infrastructure

BUT it is INEFFICIENT & COSTLY

• Staff• Training• Facilities• Recipient numbers

Donation Services 

Infrastructure

Transplantation Infrastructure

Legislative frameworks do not necessarily correlate with performance of organ, eye and tissue donation programsLegislative frameworks do not necessarily correlate with performance of organ, eye and tissue donation programs

Reason is the interdependencies within the systemReason is the interdependencies within the system

Cooperative environments for donation, medical and lifestyle history, and risk ‐ can’t formulate legislation that dictates that a donation must be accepted (pragmatism)

Cooperative environments for donation, medical and lifestyle history, and risk ‐ can’t formulate legislation that dictates that a donation must be accepted (pragmatism)

Focused amendments to create a cooperative environmentFocused amendments to create a cooperative environment

A way of increasing donation but only through the support of expanded donation and transplantation staffing and infrastructure

A way of increasing donation but only through the support of expanded donation and transplantation staffing and infrastructure