The future of organ donation in Australia: moving beyond the 'gift of life'

7 Oct 2008

Australia’s organ donation and transplantation system does not meet the nation’s present demand for organs and is unlikely to meet its future needs. This is especially so given that the demand for transplanted organs is anticipated to continue to grow with the ageing of Australia’s population and the increased incidence of lifestyle diseases such as obesity and Type 2 diabetes.

It was in recognition of the failings of Australia’s organ donation and transplantation system that the Howard Government established the National Clinical Taskforce on Organ and Tissue Donation in 2006. This Taskforce was to provide evidence-based advice to government on how the system might be changed so as to improve the rate of safe, effective and ethical donation for transplantation in Australia. The Taskforce submitted its final report in January 2008, and some of this report’s recommendations are reflected in the Rudd Government’s proposed new national reform package, announced on 2 July 2008. The Australian Organ and Tissue Donation and Transplantation Authority Bill 2008, introduced to the Parliament on 18 September 2008, would, if passed, provide the legislative framework for the proposed reform package.

Some of the Taskforce’s recommendations and the government’s proposed reforms would be likely to improve, in the short- to medium-term, Australia’s overall rates of organ donation and transplantation. However, to the extent that the Taskforce’s recommendations and the government’s proposed reforms do not depart from the terms of a ‘gift of life’ doctrine, they are unlikely to result in increased organ donation rates sufficient to meet Australia’s current or future needs. * The ‘gift of life’ doctrine insists that organ donation is an altruistic, egalitarian and essentially moral act. This paper argues that the ‘gift of life’ doctrine may be viewed as being flawed on a number of grounds, and that any changes made to Australia’s organ donation and transplantation system in the future should be premised, first and foremost, on an understanding of the act of donation as that of a rational, autonomous decision-maker.

Not only would this provide an accurate basis for Australia’s organ donation and transplantation system, but it would also allow for the widest possible range of motivations for organ donation while not compromising people’s ability to make ethical choices in donation. At the same time, grounding Australia’s organ donation and transplantation system on the notion of a rational, autonomous decision-maker could enable a number of changes to this system, the ultimate outcome of which may be an increased number of organs available for transplantation and more saved Australian and New Zealand lives.

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