A survey of more than 200 VAD practitioners identified strong support for organ donation after death in certain patients, as well as the need for further education in this space.
Combining two processes with complicated ethical and procedural considerations was never going to be easy.
Legislation for voluntary assisted dying (VAD) has been in place for all Australian states since 2023, with over 3000 Australians choosing to end their life using a VAD substance. 2023 also marked the first time Australia saw an organ donation after VAD.
A small number of other Australians have also donated organs since this initial event. However, little is known about how VAD practitioners feel about organ donation after their patient has died.
But a new Australian survey, conducted by a team of Victorian researchers, has found there is strong support for organ and tissue donation in VAD patients – but that there are also a variety of challenges in discussing and facilitating donation after death.
“This study identified strong professional support for donation amongst VAD clinicians but revealed significant challenges in translating that support into practice,” the research team wrote in the Internal Medicine Journal.
“Addressing knowledge gaps, clarifying clinical responsibilities and developing supportive policy frameworks will be critical for ensuring that organ and tissue donation following VAD occurs in a safe, ethical and patient-centred manner.”
Researchers developed an online survey containing multiple choice, Likert scale, short answer and free text questions that explored topics such as organ donation experience, education, awareness of guidelines and training materials to registered VAD health professionals from Victoria, New South Wales, Queensland and South Australia who had participated in any aspect of VAD service delivery.
VAD had not been implemented in the Northern Territory or the Australian Capital Territory at the time of the survey. There was no mention as to why VAD clinicians in Western Australia or Tasmania were not invited (or chose not) to participate, despite both states having introduced VAD legislation when the study was conducted.
The team received responses from 244 VAD clinicians across the four participating jurisdictions, accounting for roughly one in four of the VAD workforces in these states. The largest proportion of respondents came from Queensland (88, 36.1%), worked in metropolitan areas (158, 68.1%) and were doctors (165, 67.6%). Among the 167 respondents who were medical practitioners, the majority were GPs (64, 39.3%).
Ninety-eight percent of respondents were supportive of organ and tissue donation in general. Importantly, most respondents put their money (or body?) where their mouth is, with 91% indicating they were willing to donate their organs and tissues after death and 79% having registered their intent to donate on the Australian Organ Donation Register. (For context, the current national intent to donate rate is 36%.) Furthermore, more than 85% of respondents agreed organ and tissue donation had the potential to help bereaved families and save lives.
Despite the support for organ and tissue donation, less than 40% of VAD health professionals had previously received education or training in organ and tissue donation. Encouragingly, 98% of individuals knew that organ and tissue donation after VAD was possible – but 41% of respondents were not aware donation after VAD had already occurred in their jurisdiction.
Raising the topic of organ and tissue donation in end-of-life care was somewhat complicated. Ninety percent of respondents agreed (or strongly agreed) that conversations about organ and tissue donation should be part of end-of-life care in situations where donation was “possible”, but only 63% felt this issue should be routinely raised in end-of-life care.
A larger proportion of respondents preferred to initiate conversations about organ and tissue donation before referring patients to other clinicians or organisations (e.g., DonateLife) when they expressed interest in this topic.
Common concerns about discussing organ and tissue donation in all end-of-life discussions included:
- Causing confusion, false hope and additional stress to patients, families and carers.
- The fact that many VAD patients would be ineligible for organ donation due to medical contraindications and/or a preference to die at home rather than in hospital.
- The risk of perceived or actual coercion to pursue VAD and/or agree to organ donation.
Similarly, several additional barries to including organ donation in VAD practice were identified. These included the already time-consuming and bureaucratic nature of providing VAD care and the additional, often uncompensated effort that comes with pursuing the organ donation process.
Related
The researchers felt their findings had important implications for the emerging organ donation after VAD space.
“Compared to previous surveys of Australian Emergency and ICU staff, VAD clinicians appear significantly more supportive – placing them amongst the most donation-positive clinicians internationally. However, this enthusiasm does not equate to preparedness for implementation,” they wrote.
“This presents a clear opportunity for organ donation agencies to develop targeted education programmes that support informed, ethical and context-appropriate donation discussions within VAD practice.
“[There is also a need] for more effective dissemination of information and the broader absence of national guidance to support this practice. Unlike the situation for non-VAD organ donation, where joint statements and clinical guidance already exist, no comparable national framework currently guides donation after VAD.”
