Failure dressed as success: a critical examination of organ donation and transplantation policy in Australia

Abstract

Although it is often suggested that Australia’s low deceased donation rate is essentially a “virtuous artifact” due to the superiority of its public health system and its world-leading levels of public safety (leading to reductions in the types of death that may lead to organ donation), this widely accepted belief, which I have termed “Failure Dressed as Success”, has not been critically examined relative to worldwide organ donation performance. In this thesis I examine the “Failure Dressed as Success” hypothesis as an explanation for the low deceased organ donation rate in Australia, compare and contrast the effectiveness of organ donation policy in Australia in increasing its donation rate relative to international experience, and, consider alternative explanations for what may be the true reasons why Australia, for more than a quarter century, has had low deceased donation rates relative to other developed countries. This study combines three methods for examining the “Failure Dressed as Success” hypothesis: a comprehensive literature review of international organ donation history, policies and transplantation outcomes; an analysis of Australian organ donation and transplant policy from 1968-2012 relative to established determinants of deceased organ donation (i.e. causes for the types of death that are most commonly associated with organ donation); and a quantitative analysis of worldwide organ donation rates from 1989-2012 for the 90 countries that have reported donation and transplant activity.