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Ethical guidelines for organ transplantation from deceased donors submission

Submission ID: 
8
This submission reflects the views of
Organisation Name: 
Australian Medical Association
Please identify the best term to describe the Organisation: 
Non-government organisation
Personal Details
Submission - Option 1. Online submission
Specific Comments: 
3.1 Discussing transplantation

Adults with impaired decision-making capacity

We commend the NH&MRC for clearly stating that it should not be assumed adults who are intellectually impaired or have mental illness are incapable of giving consent. It’s important that the Guidelines have addressed the role of substituted, facilitated or supported decision-making, recognising that incapacity may be temporary, partial or intermittent.

We recommend, however, that the Guidelines state that adults who do lack capacity to give consent should be encouraged, to the extent possible, to take an active part in decision-making (this statement has been included for children and adolescents and should also be included for adults with impaired capacity). 

3.2.2 Organ allocation

Organ allocation

It’s important to ensure potential recipients are provided with appropriate support to adhere to the necessary ongoing treatment and health advice after transplantation. This includes not only clinical support (eg., access to medications, follow-up assessments) but also lifestyle, social and mental health support to help them comply with treatment and maximise the recipient’s health and well-being following transplantation. Certain populations such as those in rural or remote areas, indigenous Australians, people from non-English speaking backgrounds, and those with impaired capacity may require particular support in this area.  

Use of higher risk criteria organs

It’s important that the Guidelines recognise the potential benefit of using higher risk organs for those who may not meet the standard eligibility criteria, thus creating greater access to all those who require organ transplants. While the Guidelines address combined organ transplantation, it may be beneficial to specifically include a statement about the potential for doing this with higher risk criteria organs – eg., transplanting two higher risk criteria kidneys into one recipient to improve the transplanted renal function. 

General Comments: 

In order to promote and maintain community trust in Australia’s system for organ donation and transplantation, it is essential that the public understand and support the basis upon which eligibility for transplantation, suitability of organs, and allocation of organs for transplantation are made. The Guidelines clearly and comprehensively outline the ethical values and principles relevant to organ transplantation and how they apply to the protocols in Australia.  

We appreciate the fact that decisions related to organ transplantation involve complex issues, often in urgent situations, and the Guidelines state that respect should be given to the expertise and opinions of health professionals. Accountable and transparent Guidelines such as these will help inform doctors, other health professionals, potential recipients (and donors), and their family members of the decision-making criteria, hopefully making the decision-making process at the actual time a decision needs to be made a lot easier for everyone involved. 

Page reviewed: 8 April, 2016