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OTA Board Chair's report

A photograph of the OTA Board Chair with some infographics highlighting 2018 organ donation and transplantation outcomes

The Australian Government, through the Organ and Tissue Authority (OTA), has a strong and ongoing commitment to saving and improving the lives of more Australians by delivering a national program to increase organ and tissue donation and improve opportunities for transplantation.

I am pleased to report that in 2018 a record number of people received an organ transplant, driven by more Australians saying ‘yes’ to organ donation. The lives of 1,544 Australians were saved through the generosity of 554 deceased organ donors and their families. There were a further 238 recipients of organs from living donors, including 40 recipients of kidneys donated through the Australian Paired Kidney Exchange Program.

In addition to the life-saving benefits of organ transplantation, eye and tissue donation changes the lives of thousands of Australians every year – from restoration of eyesight, to regained mobility, to recovery from a serious incident. In 2018 over 10,500 Australians benefited from eye and tissue donation.

The record 2018 outcomes marked a decade of reform under the Australian Government’s national program. Significant progress has been made since the program started in 2009. The number of deceased organ donors has more than doubled and the number of transplant recipients has close to doubled. Over the 10 years, more than 11,000 Australians have received a second chance at life through organ transplantation.

Our strategic focus in 2018–19

In Australia, the potential donor's family is always asked to agree to donation in the hospital. Without this consent, donation does not proceed. As a result, further increases to the rate of organ and tissue donation relies on more individuals and their families agreeing to donate.

An area of focus in 2018–19 was to increase our consent rate. As a result of the efforts of many, the national consent rate for donation increased from 59% in 2017 to 64% in 2018 – the highest rate Australia has ever seen.

Data clearly shows that more families agree to donate when they know their family member wanted to be a donor; and when families are well-informed and supported by a donation doctor or nurse specialist. This data informed our two key strategies to lift our national consent rate by increasing the number of people on the Australian Organ Donor Register (AODR) and by ensuring donation is discussed with families by donation specialists in our hospitals.

Firstly, we continued to improve clinical practice in hospitals to better identify potential donors and to increase the involvement of DonateLife donation specialist doctors and nurses in family donation conversations. At this intensely emotional time, families must receive the best possible support and information from staff who are skilled communicators, compassionate, and knowledgeable about the donation process. In 2018 nearly eight out of 10 families agreed to donate when they were supported by a donation specialist. To support the provision of high-quality care for families throughout the donation process, we continued to deliver education and training for health professionals supporting families in conversations about the opportunity for donation.

Our second strategy involved ongoing engagement with the community to promote awareness of organ and tissue donation. This included encouraging Australians to record their decision to be a donor on the AODR and to let their family and friends know that they are a registered donor. In 2018 nine out of 10 families agreed to donation when their family member was registered. Having the discussion with your family is important, as they will have the final say. We know that many families draw comfort from being able to honour the wishes of their loved one and from helping others.

Through a range of events and activities, we appealed to the Australian community to act on their support for donation by registering and letting family members know their wishes. We continued to promote online registration through www.donatelife.gov.au, emphasising that the online form makes registration easy and takes less than a minute. We achieved a 12% increase in the number of new registrations in 2018.

Strategic direction for 2019–20

While the 2018 results are encouraging, there are still insufficient donated organs to meet the needs of those who might benefit from a transplant. At the end of 2018, more than 1,400 Australians were on a waiting list for an organ transplant. These were people suffering end-stage organ failure who were likely to die without an organ transplant. With a further 11,000 people on
dialysis, and increasing demand for tissue transplants, there are many more people who could benefit from transplantation. Clearly, we need to do more to have donation accepted as a routine part of end-of-life care in Australia.

Our main challenge is the rarity of donation. Only around 2% of people in Australia who die in hospitals have the opportunity to become a donor, as particular circumstances have to occur for a patient to be medically suitable to donate. Many more people can become eye and tissue donors as these can be donated following death in less restricted circumstances, including outside of hospital.

With donation possible in so few cases, and with so many people needing a transplant, it is important for every Australian to consider becoming a donor because through donation they can save or improve someone’s life.

In 2019–20 we will continue our focus on increasing consent rates. Lifting the national consent rate from 64% to 70% would place Australia in the world’s top 10 performing organ donation countries. The Board is confident that further growth in organ and tissue donation and transplantation is possible. It can be achieved with the continued delivery of clinical practice improvement, including the increased involvement of donation specialists in family donation conversations. The other main factor is converting public support for donation into registration and family discussion.

In particular, the Board will continue to review our efforts to increase donor registration and explore alternative registration channels. I am pleased the Board supports drivers’ licences being a channel for registration. Registration significantly increases consent rates – having a touchpoint with all Australians when they register or renew their drivers licence will make a significant impact on the number of people on the Australian Organ Donor Register. I look forward to progressing this in 2019–20.

The Board is aware that two major pieces of work currently being led by the Commonwealth Department of Health may have implications for the future role of the OTA. The National Policy Framework for the Eye and Tissue Sector is being developed as an outcome of the 2016 Review of the Australian Tissue Sector. The response to the 2018 Review of the Donation, Retrieval and Transplantation System is also progressing. Both of these projects are pending approval by Australian Health Ministers.

The Board looks forward to continuing to work with our key stakeholders in 2019–20 to sustain the growth in organ and tissue donation and ensure Australia’s health system has the capacity and capability to optimise organ and tissue donation opportunities for transplantation.

Financial performance 2018–19

We have a strong focus on budget management and ensuring that resources are appropriately allocated to optimise our performance.

The year ended with a departmental operating surplus of $0.080 million net of unfunded depreciation and before the asset revaluation adjustment, compared to a $0.041 million operating surplus in 2017–18.

Administered expenditure for 2018–19 was $43.144 million towards the delivery of the national program.

Acknowledgments

Increasing donation and transplantation requires close collaboration and cooperation with many stakeholders. We wish to acknowledge those who have contributed to the success of the national program in 2018–19.

To donate an organ or tissue for transplantation is an act of selfless generosity, and without this gift transplantation and its life-changing benefits would not be possible. So, first and foremost, the Board sincerely thanks every donor for their kindness, and every donor family for making such a generous decision during a very difficult time in their lives.

We also thank the individuals and organisations from the community who dedicate their time and expertise, often on a voluntary basis, to partner with the OTA. Together, we promote awareness of organ and tissue donation and encourage more Australians to register and talk about donation.

Donation and transplantation occur in hospitals, and the clinicians who make it happen deserve our recognition and gratitude. I want to thank them all: the dedicated and compassionate DonateLife hospital and agency staff; health professionals working in intensive care units (ICUs) and emergency departments (EDs); eye and tissue bank staff; and our transplant surgeons, physicians and coordinators.

Finally, we thank the OTA's CEO and staff whose professionalism and hard work have made a significant contribution to our success in 2018–19.

On behalf of the Board, I am very pleased to present the OTA’s 2018–19 Annual Report.

Signed by

Dr Mal Washer

Chair, OTA Board