This trend information is based on quantitative performance data for 2018. This data is reported on a calendar year basis to align with Australian and international donation and transplantation performance reporting.
In 2018 we built on the record high outcomes of 2017 and continued the trend of growth since the national program started in 2009. The lives of 1,782 Australians were saved and transformed through the generosity of 238 living organ donors and 554 deceased organ donors and their families.
Data analysis informs the national program
The collection, analysis and reporting of data to monitor, assess and inform the national program is a key area of focus for the OTA. Across the sector, data analysis informs our community engagement focus, development of family donation conversation training for hospital-based staff, medical suitability assessments, donation processes, organ allocation, and transplant practice.
In 2018–19 we continued to enhance the suite of visual dashboards that present key donation metrics to the DonateLife Network and hospital staff, and state and territory health departments, to inform and drive best practice. In particular, we developed dashboards using traffic light indicators for each hospital on the key components of the Clinical Practice Improvement Program that contribute to improved family support and rates of consent. These dashboards help hospital administrators to identify processes that can be improved to achieve best-practice organ and tissue donation.
We also continued to extend our analytical capabilities, undertaking a range of epidemiological analyses and predictive modelling to identify factors that impact donation, and identify further opportunities to increase organ and tissue donation.
In 2018–19 we worked with data providers to enhance and promote the strategic use of key data collections for donation and transplantation. In collaboration with the states and territories, we developed a set of principles covering data governance, privacy, confidentiality and security that provide a basis for nationally-consistent data collection, management, reporting and sharing. The principles aim to ensure that personal health data is appropriately managed while facilitating the use of this data for critical analysis to inform further improvement in donation and transplantation practices. The principles received support in early 2019 from all state and territory health departments, the Australian and New Zealand Intensive Care Society, the Australian Red Cross Blood Service and transplant outcome registries.
The Data Governance and Privacy Principles underpin a sector-wide Data Governance Framework which includes the key datasets in the donation and transplant processes. A primary focus of the framework is the development of a de-identified end-to-end collection of data relating to organ and tissue donation and transplantation to enable critical analysis to improve clinical practice and outcomes.
We will continue to work with our partners to implement the components of this expanded data collection in 2019–20.
Deceased organ donation and transplantation
When compared with 2017, Australia’s 2018 outcomes represent:
- a 9% increase in the number of deceased organ donors (554 donors in 2018, compared with 510 in 2017)
- a 10% increase in the number of organ transplant recipients (1,544 recipients in 2018, compared with 1,400 in 2017).
This outcome was the highest number of deceased organ donors and recipients achieved so far in Australia.
In 2018 there were 1,618 organ transplant procedures. Kidneys were the predominant organ donated and transplanted.
Organ transplant procedures 2018
There has been considerable growth in deceased organ donation and transplantation since the national program started in 2009, despite some annual variation in outcomes.
Over the 10 years of the program (2009 to 2018), 4,018 deceased organ donors and their families have benefited 11,638 transplant recipients.
The number of deceased donors has more than doubled (124% increase) and the number of transplant recipients has almost doubled (93% increase).
The deceased organ donation and transplantation outcomes for 2009, 2017 and 2018 are summarised in the figures below.
Deceased organ donors 2009, 2017 and 2018
Organ transplant recipients 2009, 2017 and 2018
Potential organ donor population and transplantation outcomes 2018
Only around 2% of people who die in hospital can become an organ donor, as particular circumstances must prevail for a patient to be medically suitable for organ donation.
By way of example (see the figure below), of the reported 78,525 deaths that occurred in hospitals in Australia in 2018, there were 1,211 potential donors identified. Requests to families for donation were made in 1,118 cases, with 716 families consenting to donation. Of those, in 162 cases donation did not proceed for a variety of medical reasons.
The resulting 554 deceased organ donors saved and transformed the lives of 1,544 organ transplant recipients and their families.
While tissue donation is a more common occurrence than organ donation – mainly due to the broader clinical circumstances in which it can occur – these circumstances are also comparatively rare.
Potential organ donor population and transplantation outcomes 2018
Deceased organ donation and transplantation rates
In 2018 the organ donation rate in Australia was 22.2 donors per million population (dpmp), a 7% increase compared with 2017 (20.7 dpmp).
The organ transplantation rate was 61.8 transplant recipients per million population (trpmp), a 9% increase compared with 2017 (56.9 trpmp).
Organ transplantation and donation rates 2009, 2017 and 2018
In 2018 organ donation rates continued to vary across states and territories, ranging from 15.8 dpmp to 32.4 dpmp. The Australian Capital Territory, Tasmania and Victoria were national leaders in donation outcomes, achieving donation rates of 26 dpmp and above. This indicates there may be potential for other jurisdictions to improve their outcomes. New South Wales, Victoria, South Australia, the Northern Territory and the Australian Capital Territory achieved growth over their 2017 outcome.
This jurisdictional variation in organ donation rates was mirrored in the organ transplantation outcomes.
Organ donation rates by jurisdiction 2009, 2017 and 2018
Deceased organ donors by donation pathway
There are two pathways to deceased donation: donation after brain death (DBD), and donation after circulatory death (DCD). The DCD pathway provides an additional opportunity for donation for those donors who will not progress to DBD, which provides the potential for increasing the donor pool.
In 2018 the majority of deceased organ donors (72%, or 400 donors) came from the DBD pathway, with the remaining 28% (154 donors) from the DCD pathway. Compared with 2017, this outcome represents an 11% increase in donations realised from the DBD pathway and a 2% increase in donations from the DCD pathway.
Deceased organ donors by donation pathway 2009, 2017 and 2018
Transplantation outcomes from living organ donors
A living organ donor is someone who donates a kidney or partial liver to another person. This is usually a relative or close friend who has end-stage kidney or liver failure.
In 2018 transplant recipients benefited from 238 living donors, compared with 273 in 2017. This represents a 21% decrease in the number of living donors since 2010 (300).
Living donors 2010, 2017 and 2018
The 2018 outcome included 40 transplants facilitated through the Australian Paired Kidney Exchange (AKX) Program.
The AKX Program increases live donor kidney transplants by identifying matches for patients who are eligible for a kidney transplant and have a living donor who is willing to donate but is not a suitable match.
The AKX Program has resulted in 286 successful live kidney transplants over the past nine years.
Australian Paired Kidney Exchange donors 2010, 2017 and 2018
Consent to donation
In Australia the family is asked to consent to donation for their loved one in the intensive care unit or emergency department.
The record number of deceased organ and tissue donors in 2018 was largely the result of more families saying yes to donation. The national consent rate was 64%, the highest rate ever recorded, and up from 59% in 2017.
Consent rates vary in each state and territory. Two jurisdictions – the Australian Capital Territory and South Australia – achieved consent rates above our national target of 70%. Other jurisdictions, notably Tasmania and Victoria, came close to achieving the national target with 67% and 68% respectively. This suggests that there may be potential for further improvement.
State and territory consent rates 2018
Further increasing consent for donation is a key factor in sustaining the growth in donation. Two key factors are integral to increasing the consent rate:
- increasing the number of people on the Australian Organ Donor Register, and encouraging people to tell their family they want to be a donor (see Objective 3: Increase registration and family discussion contributing to higher consent rates)
- ensuring donation is always raised and discussed with families by donation specialists in our hospitals (see Objective 2: Provide specialist support for families involved in the donation process).
The number of deceased donors in 2018 who donated organs, eyes and/or tissues is shown in the figure below.
Deceased organ, eye and tissue donors 2018
There were 554 deceased donors in 2018. Of these:
- 261 donated organs only
- 97 donated organs and eyes
- 66 donated organs and tissues
- 130 donated organs, eyes and tissues.
More than half of all deceased organ donors in 2018 were also eye and/or tissue donors.
Eye donation and corneal transplantation outcomes
In 2018 eye donation rates and, subsequently, corneal transplantation outcomes, continued to meet demand. Clinical experts anticipate the number of donors and corneal transplants to remain relatively constant.
There were 2,258 corneal transplants in 2018, made possible through the generosity of 1,394 eye donors and their families. This was a record number of corneal transplants, representing a 4% increase over 2017 (2,175) and a 54% increase since 2009 (1,467). Over 19,000 Australians have received a corneal transplant over the last 10 years (2009–2018).
The number of eye donors in 2018 was also a record, representing a 2% increase over the 2017 outcome of 1,369 donors and a 51% increase since 2009 (922).
Eye donors and corneal transplants 2009, 2017 and 2018
Tissue donation and transplantation outcomes
In contrast to organ and eye donation, the majority of tissue is donated by living donors. Of the 4,147 tissue donors in 2018, 92% (3,810) were living donors, resulting in 3,881 tissue donations. This represents a 2% increase in the number of living tissue donations since 2013.
Tissue donations from living donors 2013, 2017 and 2018
The 337 deceased tissue donors gave 464 tissue donations, including 226 musculoskeletal, 110 cardiovascular, 115 skin and 13 pancreas tissue donations. This outcome represents a 15% decrease compared with 2017 (547 donations) and an 18% increase since 2013 (392).
Tissue donations from deceased donors 2013, 2017 and 2018
In 2018 there were 8,261 notified tissue transplant recipients, with some recipients receiving multiple grafts. These included 7,931 recipients of musculoskeletal tissue, 234 recipients of cardiovascular tissue, 83 recipients of skin tissue, and 13 recipients of pancreas islets. This outcome is a 10% increase over 2017 (7,479) and represents more than double the number of notified tissue transplant recipients since 2013 (3,692).
Notified tissue transplant recipients 2013, 2017 and 2018
- Organ donation and transplantation data: Australia and New Zealand Organ Donation Registry, May 2019
- Consent rates: DonateLife Audit, May 2019
- Eye and tissue donation and transplantation data: Australia and New Zealand Organ Donation Registry, May 2019