Why isn't organ donation part of advance care planning?

Abstract

Organ and tissue donation preferences are not part of advance care planning (ACP) documents in Australia, either at state or national level. This includes advance directives, powers of attorney and advance resuscitation plans (such as POLST). Paradoxically, the only common advance directive in Australia is about organ donation, as this appears on 5 million driver's licenses in NSW, and 1.5 million entries on the National Organ Donor Registry. Advance care planning for the end of life and expressing a preference about organ and tissue donation have proceeded on entirely separate paths in Australia. This appears to be the same in the US. Why are preferences for organ and tissue donation kept separate from other advance decisions? Options include:

• ▶ That potential donors are a different population

• ▶ ACP is not wholly about end of life

• ▶ ACP does not address post death wishes

• ▶ There may be a perception of conflict of interest

This paper critiques these differences, suggesting that commonalities are widespread.

Given that organ and tissue donation receives 100 times the funding of ACP in Australia, there are strong motives for pursuing some linkage. A group has been established by the NSW ministry of Health to find common ground. This paper reports the findings of this group, including a suggestion that ACP documents all carry a clear message: “This Directive does not include your preferences about organ and tissue donation. To find out more about this, please go to the following website…”