In the 21st century, advances in scientific research, biotechnology and clinical care have greatly expanded the potential for organ and tissue donation and transplantation. Although the promise of xenotransplantation has not yet been realised, there have been recent successes with womb and face transplant surgery. Tissue which can be used for transplantation purposes is already being created through the use of 3D bioprinting. There is also hope that advances in both stem cell and 3D printing technologies will lead, in the not too distant future, to the creation of (solid) organs which are suitable for transplantation.
Developments in machine (or ex-vivo) perfusion of organs also offer the potential for repair and regeneration of organs, enabling more organs to be available for transplant. Notwithstanding the promise of such technologies, the current reality in Australia is that demand for human organs and tissue greatly exceeds supply.
Currently, there are around 1500 individuals on national organ transplant waiting lists. New medical treatments and technological advances, as well as the rise in the number of Australians with chronic medical conditions which require organ transplants, means that the gap between supply and demand looks set to increase in the future. Whether or not demand for tissue and organs can ever be met remains a contested issue. If demand cannot be met, it is argued that the key question in policy terms should be the design of just and fair allocation criteria in order to ensure ‘appropriate use of a scarce resource’. Nevertheless, much of the academic and policy literature in the field is focused on how best to increase rates of both deceased and living organ donation in circumstances which are ethically justified, legally permissible and politically acceptable.
This chapter examines key aspects of the organ and tissue donation and transplantation system in Australia. The types of human tissue considered are those donated and supplied for the purposes of transplantation, such as hearts, lungs, kidneys, livers, intestines and pancreases. Tissues that can be used include eyes, bones, tendons, ligaments, skin and heart valves. In addition, there are also ‘vascularised composite tissue allografts’, which involve transplantation of multiple tissues such as muscle, bone, nerve and skin, as a functional unit (for example, face or hand).