Need to improve the identification of potential organ donors

In Finland, as in many other countries, there is a dearth of suitable human organs for transplantation. Despite legislative reform in 2010, the number of transplants has not increased as was hoped. The main obstacle is the failure to identify every potential organ donor, explains Jaakko Yrjö-Koskinen, Ministerial Counsellor on health and medical affairs at the MSAH.

Efforts are now being made to improve the situation. The MSAH has appointed a working group tasked with drawing up a national plan on organ donation and transplantation, which, according to Yrjö-Koskinen, will be finalised later this year.

The plan takes account of the objectives of EU's action plan on organ donation and transplantation.

The EU action plan covers the period 2009-2015, and it comes against a background of rising demand throughout the Union for organ transplants amidst a situation of limited supply.

For some end-stage organ failures, such as renal failure, transplants are the most cost effective solutions, while for others, such as end-stage liver and heart failure they are the only viable treatment.

The EU action plan focuses on three main goals: to increase organ availability, enhance the efficiency and accessibility of transplantation systems, and improve quality and safety.

The EU plan also supports the creation of agreements among the member states on matters of transplant medicine and on monitoring the extent of organ trafficking in Europe. The Union has also called on member states to prepare national programmes to prioritise actions to improve the efficiency of transplantation systems.

Yrjö-Koskinen points out that the most important objective in Finland is to increase the availability of transplant organs.

An important means of collaboration in the Nordic area is Scandiatransplant, the organ exchange organization for Denmark, Finland, Iceland, Norway and Sweden, which covers their combined population of 25 million inhabitants. Scandiatransplant is run by the 10 hospitals that perform organ transplants in these countries.

Finnish legislation on organ donation was amended in 2010 to include presumed consent, allowing the organ donation of a suitable deceased person to be used in the treatment of another individual, unless the deceased had expressly opposed the procedure when alive.

But the amended law did not result in enough of an increase in organ donors. Yrjö-Koskinen believes there are a number of reasons for this.

"Attitudes in Finland towards organ donation are positive, and so the change to presumed consent was not such a crucial factor. Rather, we should focus on how we can better identify potential donors."

He also points out that the amended legislation has only been in force for a few years and that the sorts of changes it aims for take place gradually.

Training health service staff in the identification of potential donors is crucial. In addition to staff working in neurosurgical units, there is a need to increase the knowledge of staff working in other departments as well.

"It's important that this involves health care staff broadly. It's not just to do with staff working in intensive care, but also to improve the ability of those working in emergency rooms and, for instance, hospital wards, to recognise potential organ donors," says Yrjö-Koskinen.

Only a small percentage of deceased persons are suitable for organ donation, as the donor must have been declared brain dead. Brain death may result from massive head trauma or cerebral haemorrhage.

The number of organ donors nevertheless increased to some extent in Finland last year. Over 300 organ transplants were performed, and organs were harvested from 107 donors. Still, over 300 people are on the waiting list for transplants.

There are high expectations for the donation rate per million population (PMP). Internationally, it is recommended that countries should reach a target of 25 organ donors PMP.

"Spain, for instance, has exceeded this, and the country has some 35 organ donors for every million inhabitants. This indicates that it is feasible to increase the numbers of donors. In some Nordic countries, Denmark for example, a significant percentage of organ donors are living donors, meaning they're relatives of organ recipients. We should promote living donation in Finland too," says Yrjö-Koskinen.

Living donors can donate one of their two kidneys and retain sufficient kidney function. Single kidney donation is the most common form of organ donation from living donors.

All organ transplants performed in Finland are done at Helsinki University Central Hospital. Many types of transplant have become a routine procedure. Also, increasingly difficult transplants are being performed nowadays, such as intestine transplants.

Last year a working group operating within the Helsinki and Uusimaa Hospital District, in the south of Finland, drew up a strategy for developing organ donation in hospitals within the hospital district.

"Due to this work, it was possible to identify more donors. This shows that with decisive action, it's possible to significantly increase the availability of donor organs," says Yrjö-Koskinen.

Maija Luotonen and Mark Waller