In 2020–21 the OTA continued to provide leadership in collaboration with our DonateLife Network, governments and the clinical and community sector to navigate and minimise as best as possible the impacts to the national program due to the pandemic.
I am exceptionally proud of the team at the OTA, who have remained focused and flexible as we have moved to a much greater virtual platform whilst continuing to deliver on the key elements of the program.
The commitment and dedication of all those involved in the delivery of our national program to improve access to life-transforming transplants has never been more important. In February this year our results for the 2020 calendar year were released in our Annual Activity Report and the full impacts of the COVID-19 pandemic on our national program were realised. In 2020, there was a 12% decrease in the number of people receiving an organ and a 16% decrease in the number of organ donors compared to 2019. The most significant impact was on kidney transplants with an 18% decrease, meaning 153 less people received a kidney transplant last year.
The COVID-19 pandemic has also impacted donation and transplantation activity across the eye and tissue sector in 2020. There was a 13% decrease in the number of deceased eye donors and a 6% decrease in corneal transplants compared to 2019. Tissue donation was also impacted with a 7% decrease in deceased tissue donors – there were 290 donors in 2020 compared to 312 in 2019.
Navigating the obstacles to donation and transplantation in a COVID-19 environment has been an incredible challenge. It has included working through the logistics of retrieval clinical teams and matched organs crossing state borders in extraordinary circumstances, and restrictions to the involvement of families present in intensive care units in end-of-life care situations – a critical element in the donation process.
In this setting, saying thank you has never been more important. I would like to personally acknowledge the incredible work of the DonateLife team comprised of 265 specialist medical, nursing and support staff across 95 hospitals in Australia.
I thank them for their outstanding efforts in continuing to negotiate the many logistical challenges so donors and their families had the opportunity to donate, resulting in those needing a transplant having the best chance of a full and healthy life. My respect for the DonateLife Network could not be any greater due to their absolute dedication and resilience.
I want to thank the donor families who, despite all of the challenges of the ongoing pandemic, have committed to the incredible selfless and generous act of donation during one of the most difficult times in their lives. In 2020, 1,270 Australians received a life-changing organ transplant due to the generosity of 463 deceased organ donors and their families.
Despite a challenging year, we have not lost sight of our goal to increase donation rates and to encourage all Australians to talk about donation and register their support – to one day have the opportunity to save a life.
Our teams have continued to adapt and show resilience to try and limit further impacts on donation rates – with the ultimate aim of reaching pre-pandemic levels as soon as possible. This remains a challenge. Our national health system has been significantly impacted by the COVID-19 pandemic and we will continue to feel the long- term effects across health policy, funding and service delivery in the years to come. Our strategic focus this year has turned to the ways in which we can continue to increase donation in the future, by increasing consent, continuing to drive best practice in hospitals and normalising the donation conversation both in hospitals and the community.
We have worked closely with the transplant sector, through the Transplantation Society of Australia and New Zealand, co-leadership of the Australian COVID-19 donation and transplantation Taskforce and with our Transplant Liaison Reference Group. Members of our Vigilance and Surveillance Expert Advisory Committee also played a critical role in the COVID-19 Taskforce. I want to acknowledge everyone's shared commitment to the donation and transplantation system in Australia.
Enhancing education opportunities, data collection and sharing
This year we continued to focus on targeted education and training for our Donation Specialists who we rely on to drive and deliver the donation program in hospitals. A key part of the donation process is supporting families to make an informed decision about donation that is right for them.
In April 2021 we updated the Best PracticeGuideline for Offering Organ and Tissue Donationin Australia to continue to provide best practice approaches for referral of potential organ and tissue donors and discussing donation with their families. Evolution of the guideline is imperative in maintaining currency and to provide better care and support for families who are considering the possibility of donation for their loved one in hospital with the aim that every family making this decision is supported by a Donation Specialist.
We also continued to evolve dashboard reporting to drive donation best practice across DonateLife hospitals through the collection of data to monitor, assess and inform the national program. The DonateLife hospital reporting framework includes key metrics of the Clinical Practice Improvement Program (CPIP) aimed at driving clinical best practice in Intensive Care Units and Emergency Departments. These dashboards are provided to State and Territory Health Ministers annually with quarterly reports to the DonateLife Network and state and territory health departments to inform discussions and assist with monitoring compliance with CPIP indicators. The metrics, dashboards, reports and the data collections that underpin this framework were reviewed and enhanced during 2020–21 to keep pace with the evolving clinical performance monitoring needs.
I am also pleased to report that Australia's state of the art organ matching system, OrganMatch, continues to evolve. As at 30 June 2021, there are over 400 clinical users accessing the transplantation portal. OrganMatch is a state-of-the-art world class clinical system that manages transplant wait lists to facilitate compatibility matching of waitlisted patients and organs donated for transplants. Clinicians from the 46 transplant units across Australia can access this portal for real time patient results and reports as well as matching and transplant information for their own patients. Continual improvements are underway through the expansion of OrganMatch functionality that is aimed at benefiting patients needing a transplant by allowing better matching and will also create efficiencies in the process between the donation and transplantation clinical sectors. Most importantly these efficiencies aim to decrease timeframes for the donation process, reducing unnecessary waiting for donor families at the time of their loved one’s death.
Eye and tissue donation
Through key collaborative forums such as the OTA’s Eye and Tissue Advisory Committee (ETAC), we continue to focus on increasing eye and tissue donation in Australia particularly through increasing community awareness, increasing eye and tissue donation opportunities combined with organ donation and working with skin banks on the emergency supply of skin in Australia. We have been working closely with the Commonwealth Department of Health, who is leading the development of the National Eye and Tissue Sector Framework with states and territories, for ministerial endorsement. The OTA’s collaboration with ETAC also facilitates consultation with the Therapeutic Goods Administration (TGA) who regulate the Therapeutic Goods Orders to ensure optimal outcomes with safe, quality delivery of practices regarding eye and tissue donation and transplantation.
Support for donor families
Providing high quality care and support for donor families throughout the donation process is a core strategy for the OTA. In February 2021 a revision of the Managing correspondence between transplant recipients and donor families National Standard Operating Procedure was conducted, with a focus on timely, respectful and accountable processes. OTA and the DonateLife Network understand the importance of the correspondence they are handling and the significance it has to donor families and transplant recipients. To complement the revised National Standard Operating Procedure, an update to the associated Correspondence Guidelines was completed, to provide consistent information and support to donor families.
Restrictions on all community events due to COVID-19 did not dampen our spirits and commitment to promote and increase organ and tissue donation during DonateLife week 2020.
DonateLife Week 2020 was held from Sunday 26 July to Sunday 2 August. Our teams demonstrated extraordinary agility in delivering a complete on-line, digital campaign. Even in the absence of community events there were still 41,725 registrations over the campaign period of July and August, all of which represent extreme value to those people on waiting lists. Our digital campaign also meant that we were able to engage with some of our harder to reach audience groups.
In 2020–21 the Australian Government committed $4 million over four years for the OTA to partner with sporting, corporate and community organisations, to build on the success of previous partnerships. We also provide grants to encourage more Australians and their families to talk about organ and tissue donation. Our Community Engagement Group continued to help guide our community campaigns and I want to thank them for their ongoing dedication to raising awareness about donation. We know that increasing awareness about organ and tissue donation – focussed on encouraging families to talk about donation and registration – results in more people saying yes to donation.
Collaboration with New Zealand
Pleasingly I can report that living transplant services were able to recommence towards the middle of 2020, after being brought to a standstill at the beginning of the COVID-19 pandemic with the cessation of elective surgeries. Regrettably, our Australian and New Zealand Kidney Exchange (ANZKX) Program which was established in July 2019 and has facilitated kidney transplantation for 91 people, continued to be impacted by the COVID-19 environment with international border closures and limited flights impacting the successful exchange of donor kidneys between the two countries. Both countries agreed to continue conducting their paired kidney exchange programs independently and the ANZKX program clinical team continues to monitor developments and explore all opportunities for patients enrolled in the program, with the trans-Tasman exchange to recommence as soon as it is both safely and logistically possible.
As I reflect each year on the achievements of the OTA and DonateLife Network teams I am continually impressed at their commitment, passion and agility to achieve our purpose. The last 12 months has shown us that we will need to continue to work with this mindset as the ongoing effects of the pandemic are felt across our health system. We will also continue to work collaboratively with Governments, the clinical sector and the community to try and prevent further impacts to the national program and identify innovative ways to bring donation and consent rates back to pre-pandemic levels. We will continue to explore options to facilitate increased donor registrations, including through the state and territory licence systems and to monitor international evidence and outcomes.