Departmental Speeches

Royal Prince Alfred's 4th Annual Remembrance and Thanksgiving Service

Speech by Professor John Horvath, Chief Medical Officer, to the Royal Prince Alfred's 4th Annual Remembrance and Thanksgiving Service, 17 February 2006.

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17 February 2006

Jane, colleagues, friends of the RPA’s Transplant Unit:

It’s an honour to be here today to speak at the 4th annual organ donation remembrance and thankgiving service and I find it terrific to be back at the place that trained me and where I worked for 30 years.

As you know, Australia is internationally recognised for our strong record of successful organ transplantations, but we also have one of the world’s lowest rates of organ donations.

Over the last ten years, organ donation rates have fluctuated around 200 donors per annum. There were 204 donors in 2005, compared to 218 in 2004. Donation rates reached their lowest point in 1999, with 164 donors. Only a small number of potential donors are medically appropriate to proceed with donation.

The rate varies significantly between different states and territories.

In an effort to lift donation rates, the Commonwealth Government has strengthened the Australian Organ Donor Register to become a national register of legally valid consent. This move is designed to help ensure that people who want to donate their organs after death have their wishes respected.

This action and the work of Australians Donate and other community organisations have made a differenct but the Register still only has around 5 million people pledging their organs - this is not enough in a country of 20 million people.

If only the general public understood how important and special the gift of an organ means to someone waiting for a life saving transplant.

All the people here today have that connection to transplantation and the gift that donation bring, be it through the tragic loss of a loved one or through your own generosity in giving an organ to a relative, a child or a friend.

On behalf of all of us who have been involved in transplantation for many years, I would like to acknowledge our appreciation for your generous and often courageous actions. You are an example for the rest of the community.

I have been asked today to talk a little about transplantation and I immediately leapt at that chance.

My first connections with the Transplant Unit in fact were as finally as a medical student when David Tiller who later became one of my closest friends, colleague, Department head, as the renal registrar excitedly showed me, the new transplant room which was a subdivided two bedded room in the now demolished Blackburn Pavilion.

It was "state of the art". All the food was eradiated before it went in, all staff had to be swabbed, gowned, gloved - it was quite a performance - it was like going to the moon. I myself joined the Unit at Transplant number 11. Things hadn’t changed greatly from the early days.

What were the differences between now and then? Well in those days there was virtually no transplant waiting list.

Because of the scarcity of dialysis machines, unless you were almost super human and robust and fit for transplantation, it was unlikely you would be taken onto the transplant program.

Because there were so few dialysis machines and the criteria was so great for waiting time for a kidney really wasn’t very long. Waiting lists of course became the problem they are today progressively as dialysis facilities expanded dramatically as we of course learnt that dialysis was able to be performed on almost anybody and we ended up with large home dialysis - satellite dialysis services, but still many people waiting for transplantation.

Other major changes were of course the range of drugs we had at our disposal to treat rejection.

In the early days, in the beginning of transplantation, we really had only 2 (Prednisone and Imuran) and the sudden expansion of drugs over the 80s and 90s made transplantation a far more successful thing.

Many of you of course won’t know that one of the most important drugs - Antilymphocyte globulin, known as ALG, was in fact pioneered by Professor Ross Shiel here at Prince Alfred and Sydney University and like so many of the important innovations around transplantations, many of which Ross Shiel was responsible for.

People thought this was never going to work - how you can take serum from horses, rabbits and any other animal Ross could get hold of, would in fact have any role in transplantation?

But Ross persevered and, of course, was proven to be right - that patients treated with ALG did better than those who weren’t. That opened the whole industry of drugs that we now know are very important in the armamentarium of transplantation.

So we are at this stage today where there are significant numbers of well developed transplant programs which offer brave outcomes for people who are in the unfortunate position of needing an organ transplant bare the kidney, bare the lung, bare the heart.

The drugs are getting better, survival rates are improving and there are fewer complications - but all the time we have to bare in mind, despite the excellent contributions by science, by industry and by doctors, none of this would have been possible without the courageous actions of families and people like yourselves, who sometimes, under the most difficult circumstances, are prepared to think of the plight of others and offer organs to be donated to help other people.

So what can we expect today? Well for kidneys alone, there are around 15,000 people who have had a kidney transplant in Australia but regrettably there is still another 2,000 waiting.

Quite a number of our transplant donations now come from friends, relatives and with kidneys they make up a third of the program.

With other organs it’s much more difficult. Most liver transplants don’t come from living donors and heart and lungs remain a very difficult situation with waiting lists of recipients being much greater than the availability of organs.

Organ donation in Australia remains a matter of public interest - my own Minister, Tony Abbott, has put significant resources into this over the past two years as Health Minister. State governments have also contributed to a national effort to raise public awareness about the urgent need to lift organ donation rates.

However, we here today all understand that this is not a clear cut issue - giving and receiving an organ brings with it a range of emotional and complex responses and we must continue to work together to bring the various parties together to promote a better understanding of this special gift of life.

One famous person who wanted to do everything he could to promote organ donation awareness was the late Kerry Packer who, following his kidney transplantation said to me, "what can I do in return - who can I give a gift to?"

We talked at some length about all the people involved in transplantation from the surgeon who put the kidney in; to the medical staff who managed the immunosuppression; to the porters who took him to and from x-ray and the great team effort, as you all know that makes a transplant.

So it is with his generosity that he thought an education centre for the whole campus was the most appropriate way that he could say thank you and also to donate money to the transplant clinic up on level 9 to be named after Nick Ross, who so generously gave him a kidney.

It is an honour and privilege to be involved in this transplant ceremony today in this beautiful auditorium made possible by the very generous gift by Kerry Packer.

So once again thank you for asking me to be here but most importantly, thank you to all of you who have been generous in thinking of others and making it possible for people in need to receive vital organs for transplantation.

Thank you.