A WA parliamentary question explores the feasibility of organ donation from registered donors in regional hospitals, focusing on logistical and financial challenges in comparison to transferring patients to Perth.

AnsweredQoN 2798Legislative Assembly
Asked
4 May 2004
Portfolio
Health

QuestionView source ↗

(1) Is it true that registered organ donors who die in country Western Australian hospitals cannot have their organs made available for donation?
(2) If yes, what are the impediments to this situation being reversed?
(3) What proportion of the State’s potential organ donors die in country Western Australia and hence cannot have their organs used for transplanting purposes?
(4) Why can the larger regional hospitals such as Bunbury not be equipped with appropriate life support equipment so that persons who are declared to be brain dead can be kept alive so that their organs can be made available for donation?
(5) In the situation that the larger regional hospitals could be provided with appropriate life support equipment, what would be the cost and logistical issues needing to be resolved for a surgical ‘flying squad’, based in Perth, to be flown to these hospitals when a donor is available so that their organs can be removed and taken by air to Perth where they can be used for transplanting?
(6) Alternatively, what facilities and staff would be required to allow these brain dead but physically alive people to be transported to Perth by air ambulance so that their organs can be removed in one of the Perth hospitals set up to undertake such tasks?

AnswerView source ↗

Answered
3 June 2004
Responded by
Minister for Health
Response time
30 days
However, all critically ill and possibly brain dead persons are transferred to Perth for treatment where possible. Over the past three years, approximately one third of the organ donors have come from country people yet only one quarter of the population live in the country. This demonstrates that country people contribute significantly to Western Australia’s organ donation rate. Furthermore, all 3 organ donors to date for 2004 have been transferred from country WA. 2) Country hospitals do not have Intensive Care Units (ICU) to support brain dead people and they usually do not have two specialists trained in diagnosing brain death. Rural hospitals do not have all the essential staff or equipment required to maintain an ICU. The nursing and medical staff must be clinically competent for all situations pertaining to organ donation and, with the small numbers of patients needing true ICU care in the rural sector, this cannot be logistically managed. Some larger rural facilities have a high dependency unit for the care of more seriously ill patients and for the stabilisation of critical patients prior to their transfer to the metropolitan tertiary hospitals, if required. Royal Flying Doctor Service (RFDS) planes are suitably equipped and staffed to manage the transfer of the critically ill patients. 3) All critically ill and possibly brain dead persons are transferred to Perth for treatment where possible. No data is kept on potential organ donors not transferred to Perth but it is thought this number is relatively low. 4) Most larger regional hospitals have “life support” equipment that could be used to ventilate brain dead people. For example, Bunbury Regional Hospital has 3 ventilators and 3 transport ventilators available for respiratory support for potential organ donors. These ventilators keep head injured individuals breathing while they await the RFDS to transport them to Perth for more specialised assessment and treatment. Numerous other rural sites have a ventilator or a portable ventilator or anaesthetic machine but do not the have the coverage of suitably skilled medical and nursing staff available to use this equipment at any time of the day or night. However, this ventilatory equipment in itself is not enough for a hospital to prepare and sustain an organ donor. For example, there also needs to be medical expertise to diagnose brain death and to assess whether the donor’s organs are suitable for transplant. Other logistical requirements must be met, such as adequate theatre resources for surgery, the timely transport of the organs from the regional hospital and additional investigative procedures required for declaring brain death (eg nuclear scans and/or cerebral blood flows). 5) Assuming the logistical requirements mentioned in 4) above are met, then to undertake a multi-organ retrieval in a rural hospital would require a team of between 7 and 9 people to be flown into the town. The exact number would depend on the availability of anaesthetists and theatre nurses within the country centre. In addition, that hospital would need to be accredited for cardiac and other specialised surgery. The cost of charter flights for this purpose would range from $5,000, for centres like Albany, Geraldton and Bunbury, to $11,000 for centres like Karratha. An accurate quote cannot be obtained for Broome and Kununurra, but it is estimated that it would cost around $20,000. These latter towns have higher costs because the flight time plus the time on the ground would probably require two pilots to be on board. 6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
2) Country hospitals do not have Intensive Care Units (ICU) to support brain dead people and they usually do not have two specialists trained in diagnosing brain death. Rural hospitals do not have all the essential staff or equipment required to maintain an ICU. The nursing and medical staff must be clinically competent for all situations pertaining to organ donation and, with the small numbers of patients needing true ICU care in the rural sector, this cannot be logistically managed. Some larger rural facilities have a high dependency unit for the care of more seriously ill patients and for the stabilisation of critical patients prior to their transfer to the metropolitan tertiary hospitals, if required. Royal Flying Doctor Service (RFDS) planes are suitably equipped and staffed to manage the transfer of the critically ill patients. 3) All critically ill and possibly brain dead persons are transferred to Perth for treatment where possible. No data is kept on potential organ donors not transferred to Perth but it is thought this number is relatively low. 4) Most larger regional hospitals have “life support” equipment that could be used to ventilate brain dead people. For example, Bunbury Regional Hospital has 3 ventilators and 3 transport ventilators available for respiratory support for potential organ donors. These ventilators keep head injured individuals breathing while they await the RFDS to transport them to Perth for more specialised assessment and treatment. Numerous other rural sites have a ventilator or a portable ventilator or anaesthetic machine but do not the have the coverage of suitably skilled medical and nursing staff available to use this equipment at any time of the day or night. However, this ventilatory equipment in itself is not enough for a hospital to prepare and sustain an organ donor. For example, there also needs to be medical expertise to diagnose brain death and to assess whether the donor’s organs are suitable for transplant. Other logistical requirements must be met, such as adequate theatre resources for surgery, the timely transport of the organs from the regional hospital and additional investigative procedures required for declaring brain death (eg nuclear scans and/or cerebral blood flows). 5) Assuming the logistical requirements mentioned in 4) above are met, then to undertake a multi-organ retrieval in a rural hospital would require a team of between 7 and 9 people to be flown into the town. The exact number would depend on the availability of anaesthetists and theatre nurses within the country centre. In addition, that hospital would need to be accredited for cardiac and other specialised surgery. The cost of charter flights for this purpose would range from $5,000, for centres like Albany, Geraldton and Bunbury, to $11,000 for centres like Karratha. An accurate quote cannot be obtained for Broome and Kununurra, but it is estimated that it would cost around $20,000. These latter towns have higher costs because the flight time plus the time on the ground would probably require two pilots to be on board. 6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
3) All critically ill and possibly brain dead persons are transferred to Perth for treatment where possible. No data is kept on potential organ donors not transferred to Perth but it is thought this number is relatively low. 4) Most larger regional hospitals have “life support” equipment that could be used to ventilate brain dead people. For example, Bunbury Regional Hospital has 3 ventilators and 3 transport ventilators available for respiratory support for potential organ donors. These ventilators keep head injured individuals breathing while they await the RFDS to transport them to Perth for more specialised assessment and treatment. Numerous other rural sites have a ventilator or a portable ventilator or anaesthetic machine but do not the have the coverage of suitably skilled medical and nursing staff available to use this equipment at any time of the day or night. However, this ventilatory equipment in itself is not enough for a hospital to prepare and sustain an organ donor. For example, there also needs to be medical expertise to diagnose brain death and to assess whether the donor’s organs are suitable for transplant. Other logistical requirements must be met, such as adequate theatre resources for surgery, the timely transport of the organs from the regional hospital and additional investigative procedures required for declaring brain death (eg nuclear scans and/or cerebral blood flows). 5) Assuming the logistical requirements mentioned in 4) above are met, then to undertake a multi-organ retrieval in a rural hospital would require a team of between 7 and 9 people to be flown into the town. The exact number would depend on the availability of anaesthetists and theatre nurses within the country centre. In addition, that hospital would need to be accredited for cardiac and other specialised surgery. The cost of charter flights for this purpose would range from $5,000, for centres like Albany, Geraldton and Bunbury, to $11,000 for centres like Karratha. An accurate quote cannot be obtained for Broome and Kununurra, but it is estimated that it would cost around $20,000. These latter towns have higher costs because the flight time plus the time on the ground would probably require two pilots to be on board. 6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
4) Most larger regional hospitals have “life support” equipment that could be used to ventilate brain dead people. For example, Bunbury Regional Hospital has 3 ventilators and 3 transport ventilators available for respiratory support for potential organ donors. These ventilators keep head injured individuals breathing while they await the RFDS to transport them to Perth for more specialised assessment and treatment. Numerous other rural sites have a ventilator or a portable ventilator or anaesthetic machine but do not the have the coverage of suitably skilled medical and nursing staff available to use this equipment at any time of the day or night. However, this ventilatory equipment in itself is not enough for a hospital to prepare and sustain an organ donor. For example, there also needs to be medical expertise to diagnose brain death and to assess whether the donor’s organs are suitable for transplant. Other logistical requirements must be met, such as adequate theatre resources for surgery, the timely transport of the organs from the regional hospital and additional investigative procedures required for declaring brain death (eg nuclear scans and/or cerebral blood flows). 5) Assuming the logistical requirements mentioned in 4) above are met, then to undertake a multi-organ retrieval in a rural hospital would require a team of between 7 and 9 people to be flown into the town. The exact number would depend on the availability of anaesthetists and theatre nurses within the country centre. In addition, that hospital would need to be accredited for cardiac and other specialised surgery. The cost of charter flights for this purpose would range from $5,000, for centres like Albany, Geraldton and Bunbury, to $11,000 for centres like Karratha. An accurate quote cannot be obtained for Broome and Kununurra, but it is estimated that it would cost around $20,000. These latter towns have higher costs because the flight time plus the time on the ground would probably require two pilots to be on board. 6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
However, this ventilatory equipment in itself is not enough for a hospital to prepare and sustain an organ donor. For example, there also needs to be medical expertise to diagnose brain death and to assess whether the donor’s organs are suitable for transplant. Other logistical requirements must be met, such as adequate theatre resources for surgery, the timely transport of the organs from the regional hospital and additional investigative procedures required for declaring brain death (eg nuclear scans and/or cerebral blood flows). 5) Assuming the logistical requirements mentioned in 4) above are met, then to undertake a multi-organ retrieval in a rural hospital would require a team of between 7 and 9 people to be flown into the town. The exact number would depend on the availability of anaesthetists and theatre nurses within the country centre. In addition, that hospital would need to be accredited for cardiac and other specialised surgery. The cost of charter flights for this purpose would range from $5,000, for centres like Albany, Geraldton and Bunbury, to $11,000 for centres like Karratha. An accurate quote cannot be obtained for Broome and Kununurra, but it is estimated that it would cost around $20,000. These latter towns have higher costs because the flight time plus the time on the ground would probably require two pilots to be on board. 6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
5) Assuming the logistical requirements mentioned in 4) above are met, then to undertake a multi-organ retrieval in a rural hospital would require a team of between 7 and 9 people to be flown into the town. The exact number would depend on the availability of anaesthetists and theatre nurses within the country centre. In addition, that hospital would need to be accredited for cardiac and other specialised surgery. The cost of charter flights for this purpose would range from $5,000, for centres like Albany, Geraldton and Bunbury, to $11,000 for centres like Karratha. An accurate quote cannot be obtained for Broome and Kununurra, but it is estimated that it would cost around $20,000. These latter towns have higher costs because the flight time plus the time on the ground would probably require two pilots to be on board. 6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
The cost of charter flights for this purpose would range from $5,000, for centres like Albany, Geraldton and Bunbury, to $11,000 for centres like Karratha. An accurate quote cannot be obtained for Broome and Kununurra, but it is estimated that it would cost around $20,000. These latter towns have higher costs because the flight time plus the time on the ground would probably require two pilots to be on board. 6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
6) Current facilities already allow for head injured people to be transported to Perth with the RFDS air ambulance. The existing staff of doctors and nurses who transfer head injured patients to Perth are all that is needed. The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
The operational cost of a flight varies according to the distance flown. For example, an air ambulance flight from Bunbury to Perth costs around $5,000 whilst one from Derby costs around $25,000. It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.
It should be noted that if demand for air ambulance transport exceeds current service provision capacity, further resources would be required for an additional aircraft and associated staffing.

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