The shortage of kidneys for transplantation in Australia

In reply: We regret that Raper et al have misinterpreted our editorial on the shortage of donor kidneys in Australia.1 We are particularly concerned and indeed mystified by their last statement, where they state that we implied that “poor performance and . . . lack of commitment” were to blame. This was in no manner our message. Rather, we sought to emphasise that all possibilities to optimise local donation rates should be explored, so desperate patients seeking grafts from potentially dangerous overseas sources need not expose themselves to serious potential morbidity and mortality.

We consider that our intensive care colleagues perform superbly under the most difficult of circumstances when managing potential organ donation. We understand they are often unsupported with managing potential donations while they must at the same time deal with the grieving family, and the immediate demands of treating other seriously ill patients. We simply suggest that problems within the system (for example, differences between states in the number of intensive care beds per head of population or in the provision of specifically funded donor coordinators) that might hinder increasing organ donation should be carefully examined.

We believe it is unhelpful to suggest that the South Australian experience should simply remain unexplained. In the article by Opdam and Silvester (cited by Raper et al), of 112 potential donors, 46 were considered medically suitable unrealised potential donors, and their estimated maximal potential donor rate was 30 per million,2 remarkably similar to the rates seen in Spain (the country with the highest organ donor procurement rate) and South Australia. We agree with the conclusions of Opdam et al that “an increase in the organ donation rate may be possible through increasing consent and the identification and support of potential donors”. As they also state, this would require substantial changes in clinical practice, with resource and ethical complications

We did not mean to offend our intensivist colleagues. We merely suggest that we all need to assess the systems in which donation occurs and attempt to improve donation rates, for the sake of the many desperate people awaiting organ transplants in this country.