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Chapter 11 Tissue & Eye Donation 216 Annual Report Data to 31-Dec-21

The partnership between the Australian Organ and Tissue Authority (OTA), jurisdictional tissue and eye banks and the ANZOD Registry continues to strengthen the national reporting of tissue data. This chapter presents the data on tissue and eye donation provided by tissue and eye banks across Australia, in conjunction with data collected within the solid organ donation sector. The aim for the ANZOD Registry is to continue delivering accurate data for the tissue and eye sectors. The goals include the collection of donor specific data, outcome data and aligning terminology across agencies. Collaboration with the Eye Bank Association of Australia and New Zealand (EBAANZ) is assisting the accurate reconciliation for reporting. The following tissue banks contributed data: The following eye banks contributed data: NSW QLD SA - Australian Biotechnologies - Hunter New England Bone Bank - NSW Bone Bank - Rachel Forster Bone Bank - Sydney Heart Valve Bank - QLD Bone Bank - QLD Heart Valve Bank - SA Tissue Bank NSW QLD SA VIC WA NZ - Lions NSW Eye Bank - Queensland Eye Bank - The Eye Bank of SA - Lions Eye Donation Service (Vic) - Lions Eye Bank of WA - NZ National Eye Bank VIC - Barwon Health Bone Bank Geelong - Donor Tissue Bank Victoria WA - Perth Bone and Tissue Bank (PlusLife) Reported datasets and analyses produced here inform the discussions held by health care professionals, policy makers, consumers and individual agencies to optimise every potential donation opportunity and to increase access to life-transforming transplantation for Australians - See more at: http://www.donatelife.gov.au/organ-and-tissue-authority-ota. 11 2

Tissue Donors In 21, tissue banks across Australia continued to provided data for, cardiovascular, musculoskeletal and skin tissue donations from a total of,293 tissue donors. Figures 11.1 shows the number of tissue donors in each jurisdiction (both living and deceased combined) for 213, 21 and 21. Each total number excludes duplicate counts of donors that are also multi-organ and tissue donors or multi-tissue donors where the donor coordination is performed by another donation agency. This data is sourced from Australian tissue banks. Figure 11.1 1, 1,2 of Tissue Donors by Jurisdiction, 213-21 1 1321 113 213 21 21 1, 936 93 9 79 723 79 629 9 6 29 261 2 61 36 2 3 1 1 QLD NSW ACT VIC TAS SA WA 11 3

Table 11.1 shows the number of tissue donors, by donation pathway, by jurisdiction and the percentage change in donor numbers from 21 to 21. Nationally there was a 9% increase in the number of deceased tissue donors in 21. Living tissue donor numbers increased by 7% resulting in an overall increase in tissue donors for 21 compared to 21. Table 11.1 of Tissue Donors by Donation Pathway, Jurisdiction, 21-21 Donor Pathway Jurisdiction 21 21 Change in donation Living Tissue Donor Deceased Tissue Donor Total Donors QLD 2 (22.2%) (2.3%) 2% NSW 12 (3%) 19 (3%) 17% ACT (%) (%).% VIC 7 (19.1%) 62 (1.6%) 1% TAS 36 (1%) 1 (1.3%) 29% SA 2 (7%) 396 (1%) 3% NT (%) (%).% WA 62 (16.7%) 9 (1.%) % AUS 37 (1%) 3973 (1%) 7% QLD 26 (9%) 21 (2.2%) 6% NSW (16.3%) 112 (19.6%) 2% ACT 3 (.6%) 1 (.2%) 2% VIC 16 (29.9%) 12 (31.9%) 1% ACT 1 (.2%) (.7%) 7% SA (1%) 13 (2.3%) 62% NT 2 (.%) (%).% WA 1 (2.7%) 1 (3.2%) 22% AUS 22 (1%) 71 (1%) 9% QLD 1 (2.6%) 19 (23.1%) 3% NSW 133 (31.%) 1621 (3.7%) 17% ACT 3 (.1%) 1 (%) 2% VIC 6 (2.%) 2 (17.6%) % TAS 37 (.9%) (1.2%) 33% SA 263 (6.2%) 9 (9%) 36% NT 2 (%) (%).% WA 63 (1%) 67 (13.%) % AUS 226 (1%) (1%) 7% 11

Figure 11.2 Living Tissue Donors by Jurisdiction, 21-21 Among the tissue donors in Australia during 21, there were 3,973 living donors compared to 3,7 in 21. Figure 11.2 shows the number of living donors by jurisdiction for 21 and 21. Five tissue banks in NSW accounted for 3% (1,9) of living tissue donors. of Donors 1,3 1,2 1,1 1, 9 7 6 3 2 19 12 7 62 2 396 21 21 62 9 2 1 36 1 QLD NSW ACT VIC TAS SA NT WA Figure 11.3 There were 71 deceased tissue donors in Australia in 21, an increase of 9% from 22 in 21. Figure 11.3 shows the breakdown by jurisdiction for 21 and 21. Of the 71 deceased tissue donors, 21(2.2%) donors were reported by the two tissue banks located in QLD. of Donors 1 9 7 6 3 2 1 Figure 11. 11 166 Deceased Tissue Donors by Jurisdiction, 21-21 39 3 1 9 13 1 6 QLD NSW ACT VIC TAS SA NT WA 21 21 Deceased Solid Organ and Tissue Donors by Jurisdiction, 21-21 Of the 71 deceased tissue donors in Australia, in 21, 23 (.3%) were reported through the solid organ and tissue donation sector. These donors were referred by the DonateLife Network. Figure 11. provides the breakdown by jurisdiction in tissue donations from deceased solid organ and tissue donors for 21 and 21. of Donors 3 3 2 2 1 1 7 7 6 69 2 1 61 79 QLD NSW ACT VIC TAS SA NT WA 1 12 2 21 21 13 11

Donation of Tissue The,293 tissue donors in Australia during 21, accounted for, tissue donations. Of these, donations of musculoskeletal, cardiovascular and skin tissue, 3,973 (7.%) were from live donors and 71 (12.%) were tissue donations from deceased donors. Figure 11. shows the breakdown by jurisdiction for the total number of tissue donations by year, 213 to 21 Figure 11. 1, Total Tissue Donation by Jurisdiction, 213-21 133 1621 213 21 21 1,2 1 19 1196 1, 97 96 6 2 71 6 63 67 33 263 9 2 62 37 3 1 1 QLD NSW ACT VIC TAS SA WA Table 11.2 provides the proportion of tissue donations by Jurisdiction by donor type for 21-21. 11 6 Table 11.2 of Tissue Donations by Donor Type, Jurisdiction 21-21 Donor Type Jurisdiction 21 21 QLD 2 (22.2%) (2.3%) NSW 12 (3%) 19 (3%) ACT (%) (%) Living Donor VIC 7 (19.1%) 62 (1.6%) TAS 36 (1%) 1 (1.3%) SA 2 (7%) 396 (1%) WA 62 (16.7%) 9 (1.%) AUS 37 (1%) 3973 (1%) QLD 26 (9.2%) 21 (2.2%) NSW (16.3%) 112 (19.6%) ACT 3 (.6%) 1 (.2%) Deceased Donor VIC 16 (3%) 12 (31.9%) TAS 1 (.2%) (.7%) SA (1%) 13 (2.3%) WA 1 (2.7%) 1 (3.2%) AUS 2 (1%) 71 (1%) QLD 1 (2.6%) 19 (23.1%) NSW 133 (31.%) 1621 (3.7%) ACT 3 (.1%) 1 (%) Total Donors VIC 6 (2.%) 2 (17.6%) TAS 37 (.9%) (1.2%) SA 263 (6.2%) 9 (9%) WA 63 (1%) 67 (13.%) AUS 22 (1%) (1%)

Figures 11.6 to 11. show the breakdown by living tissue, deceased tissue only and solid organ and tissue donation, by Jurisdiction, for the period 213 to 21. Among the 3,973 living tissue donations in Australia during 21, NSW and QLD recorded an increase in donation numbers compared to 21, with NSW reporting 3% (1,9) of living tissue donations. Figure 11.6 Donation by Donation Pathway 1,3 1,2 1,1 1, 9 7 6 3 2 1 Tissue Donation by Living Donors by Jurisdiction, 213-21 6 2 1136 12 19 62 7 7 62 36 1 299 2 396 66 62 9 QLD NSW ACT VIC TAS SA WA 213 21 21 Figure 11.7 Tissue Donation by Deceased Donors by Jurisdiction, 213-21 Of the 71 tissue donations from deceased donors in 21, 31 (.7%) came from tissue only donors. Figure 11.7 shows the breakdown by Jurisdiction for 212 to 21. QLD reported 166 (29.1%) tissue only donations. This was a decrease of 1 donors compared to 21 (11). Donation by Donation Pathway 2 1 16 1 12 1 6 2 9 11 166 2 39 3 1 73 13 9 1 QLD NSW ACT VIC TAS SA WA 2 213 21 21 6 Figure 11. Solid Organ & Tissue Donation by Deceased Donors by Jurisdiction, 213-21 Of the 71 deceased tissue donors in Australia, in 21, 23 (.3%) were reported through the solid organ and tissue donation sector. These donors were referred by the DonateLife Network. Figure 11. provides the breakdown by jurisdiction of tissue donations from deceased solid organ and tissue donors for the period 212 to 21. Donation by Donation Pathway 1 9 7 6 3 2 1 7 7 7 36 6 69 2 1 3 61 79 1 1 12 12 QLD NSW ACT VIC TAS SA WA 213 21 21 13 11 7

Tissue Donation Musculoskeletal donations can be in the form of bone, tendon and ligaments and are utilised for knee and hip replacements, reconstructive orthopaedic surgery following trauma or disease and spinal deformities and can aid in prevention of limb loss following tumour removal. Just one musculoskeletal donation can aid many recipients and greatly improve their quality of life. Cardiovascular tissue incorporates donations of heart valves, pericardium and thoracic aorta. Heart valves are necessary to regulate the flow of blood to and from the heart, whereas pericardium can be used during neurosurgery or, like the thoracic aorta, can also be used for vascular repair of defects or injury. Donated skin contributes to saving lives and improving long term outcomes for patients who suffer severe burns. Donated skin is essential when a patient s own skin cannot be used for grafting. Using donated skin as a wound dressing helps reduce infection, fluid loss and pain, promotes wound healing and minimises scarring. Often recipients will require more than one donated graft for their wounds to heal. Skin grafts are also used to treat wounds resulting from trauma and serious infection. Deceased Donor Tissue Donation The 71 tissue donations from deceased donors in 21 included donations from tissue only and solid organ/tissue donors. This consisted of 233 musculoskeletal tissue, 11 cardiovascular tissue, 171 skin and 16 pancreas islets. Overall this is a 11.% increase of deceased tissue donations compared to 21. Table 11.3 shows the donation for tissue retrieved from deceased donors, by tissue type and donation sector..7% (31) of tissue retrieved from deceased donors was from the tissue only sector, while.3% (23) was from the solid organ/tissue sector. Table 11.3 Tissue Donation from Deceased Donors in 21 by Jurisdiction and Donation Sector Jurisdiction Tissue Only Sector Solid Organ/Tissue Sector Tissue Total ms cv skin pi ms cv skin pi ms cv skin pi QLD 7 19 73 2 21 27 2 99 1 NSW 3 31 3 3 69 ACT 1 1 VIC 32 2 6 19 27 2 1 2 71 TAS SA 1 1 2 11 WA 1 1 2 1 1 3 AUSTRALIA 1 1 119 1 2 16 233 11 171 2 3 2 1 16 ms = musculoskeletal tissue cv = cardiovascular tissue pi = pancreas islets 11

In Australia during 21, there were 233 musculoskeletal tissue donation from deceased donors. Figure 11.9 shows the number of musculoskeletal tissue donations by jurisdiction for the period 212 to 21. Forty two percent (99) of the 233 musculoskeletal donations were reported by the QLD Bone Bank. Figure 11.9 Donation by Tissue Type, 3, 3, 2, 2, 1, 1, 6 2 213 21 21 Musculoskeletal Tissue Donation by Living Donors by Jurisdiction, 213-21 123 1119 19 62 777 76 616 36 1 299 2 396 66 62 9 379 367 39 QLD NSW ACT VIC TAS SA WA AUS Figure 11.1 Cardiovascular Tissue Donation by Living Donors by Jurisdiction, 213-21 Figure 11.1 shows the breakdown by jurisdiction for cardiovascular tissue donation for the period 212 to 21. Eighty seven percent all cardiovascular donations come from the eastern jurisdictions of Australia (QLD, NSW, VIC). Donation by Tissue Type 3 2 2 1 1 213 21 21 17 1 11 2 17 1 3 2 QLD NSW ACT VIC TAS SA WA AUS Figure 11.11 Musculoskeletal Tissue Donation by Deceased Donors by Jurisdiction, 213-21 QLD and VIC are the only two jurisdictions with skin donation services. Figure 11.11 shows the breakdown of skin donations between the two jurisdictions for the period 212 to 21. Donation by Tissue Type 2 21 1 1 12 9 7 1 99 213 21 21 69 1 23 233 6 3 1 6 3 3 29 19 1 9 QLD NSW ACT VIC TAS SA WA AUS 11 9

Tissue Donation from Living Donors Tissue donations from living donors (7.% of all donations) consisted predominately of musculoskeletal tissue, where 3,9 people donated femoral heads whilst undergoing hip replacement surgery. Table 11. shows tissue donation from living donors. Fifteen living donors provided cardiovascular tissue, down from 17 in 21. Tissue donation from living donors is managed by the tissue banks across Australia. Table 11. Tissue Donation from Living Donors in 21 by State and Donation Sector Jurisdiction Musculoskeletal Cardiovascular Total QLD NSW 19 11 19 ACT VIC 616 62 TAS 1 1 SA 396 396 WA 9 9 AUSTRALIA 39 1 3973 Figure 11.12 shows the numbers of musculoskeletal tissue donations from living donors by Jurisdiction for the period 212-21. Figure 11.12 Donation by Tissue Type 1 13 12 1 9 7 6 Cardiovascular Tissue Donation by Deceased Donors by Jurisdiction, 213-21 213 21 21 37 6 2 19 12 11 3 1 2 21 11 13 3 1 1 3 3 QLD NSW ACT VIC TAS SA WA AUS Figure 11.13 Skin Tissue Donation by Deceased Donors by Jurisdiction, 213-21 1 16 1 213 21 21 171 16 Figure 11.13 shows the number of skin tissue donations from deseased donors by Australian jurisdictions for the period 212-21. Donation by Tissue Type 13 12 1 9 7 6 72 12 1 1 63 71 123 3 1 QLD NSW ACT VIC TAS SA WA AUS 11 1

Tissue Transplantation In 21, national tissue reporting continued to strengthen with the consolidated collection and reporting of tissue donation outcomes by capturing tissue transplantation numbers in Australia. Tissue banks provided the number of notified graft tissue transplants and the number of notified recipients of tissue transplantation. Musculoskeletal, cardiovascular and skin tissue donated for the purpose of transplantation can be stored for a period of time before a transplant occurs. Therefore the numbers reported for grafts and recipients of tissue, in this section, represent transplantation outcomes for the reporting period only, not the outcome of donations for the reporting period. A tissue transplant recipient can receive one or more tissue grafts in one or more transplant events. Tissue transplantation counts are reported by tissue banks as the number of notified transplants and notified recipients from tissue retrieved by that tissue bank. Figure 11.1 shows the number of notified (1,2) tissue transplants (grafts) and recipients by Jurisdiction for 21. Figure 11.1 of Notified Tissue Transplants and Recipients (ms,cv,sk) by Jurisdiction, 21 6,,, 66 Transplants (Australia = 12) Recipients (Australia = 6),, 3, 3, 3177 37 2, 2, 1776 1, 1, 91 3 139 9 9 6 QLD NSW VIC SA WA (1) Notified tissue transplant is defined as the of grafts implanted into recipients, that banks have been notified of. (2) Notified tissue recipient is defined as the of recipients notified to the bank, who receive one or more graft implants during a single transplant event. 11 11

Figure 11.1 Pancreas Islets Donation by Deceased Donors by Jurisdiction, 213-21 Figure 11.1 shows the number of pancreas islets donations by deceased donors by Jurisdiction, for 213-21. In Australia, there were 16 pancreas islets donations by deceased donors. Donation by Tissue Type 2 16 12 213 21 21 1 16 3 2 2 2 1 1 1 1 1 1 QLD NSW ACT VIC TAS SA WA AUS Figure 11.16 of Notified Musculoskeletal Transplants and Recipients by Jurisdiction, 21 Figure 11.16 shows the number of notified (1,2) musculoskeletal tissue transplants and recipients, by Jurisdiction, for 21. 6,,, 362 Musculoskeletal Transplants (AUS = ) Musculoskeletal Recipients (AUS = 617) In Australia, there were 6,17 recipients who received, musculoskeletal transplants. 3, 33 2, 29 167 1, 33 9 6 139 9 QLD NSW VIC SA WA Figure 11.17 of Notified Cardiovascular Transplants and Recipients by Jurisdiction, 21 Figure 11.17 shows the number of notified (1,2) cardiovascular tissue transplants and recipients by Australian Jurisdiction, for 21. 12 1 1 13 Cardiovascular Transplants (AUS = 213) Cardiovascular Recipients (AUS = 212) In Australia, there were 212 recipients who received 213 cardiovascular transplants. 6 7 7 62 62 2 QLD NSW VIC SA WA (1) Notified tissue transplant is defined as the of grafts implanted into recipients, that banks have been notified of. (2) Notified tissue recipient is defined as the of recipients notified to the bank, who receive one or more graft implants during a single transplant event. 11 12

Figure 11.1 shows the number of notified (1,2) skin tissue transplants and recipients by Jurisdiction, for 21. In Australia, there were 13 recipients who received 1,379 skin transplants. Figure 11.1 of Notified Skin Tissue Transplants and Recipients by Jurisdiction, 21 1,2 1, 11 Skin Tissue Transplants (AUS = 11) Skin Tissue Recipients (AUS = 9) 6 3 2 1 3 QLD NSW VIC SA WA Figure 11.19 shows the number of notified (1,2) musculoskeletal tissue transplants and recipients, by Jurisdiction, for 21. In Australia, there were,27 recipients who received 7, musculoskeletal transplants. Figure 11.19 of Pancreas Islet Tissue Transplants and Recipients by Jurisdiction, 21 12 Pancreas Islet Tissue Transplants (AUS = 1) Pancreas Islet Tissue Recipients (AUS = 1) 1 6 2 2 2 NSW VIC SA (1) Notified tissue transplant is defined as the of grafts implanted into recipients, that banks have been notified of. (2) Notified tissue recipient is defined as the of recipients notified to the bank, who receive one or more graft implants during a single transplant event. 11 13

Eye Donors In 21, eye banks across Australia continued to report data to the ANZOD Registry for eye donation. Total numbers reported in this section may include duplicate counts of donors that are also multi-organ and tissue donors or multitissue donors, where the donor coordination was performed by another donation agency. Where there is no eye bank in a jurisdiction, eye donation is managed from a satellite Jurisdiction. This data is sourced from Australian eye banks in conjunction with EBAANZ. Figure 11.2 represents the number of eye donors from each Australian Jurisdiction for the reporting period 213 to 21. In 21 there were 1,266 eye donors (Figure 11.21), compared with 1,162 in 21 and 1,1 in 213. Figure 11.2 1,2 1,1 1, 9 7 6 3 2 1 333 33 39 37 376 3 of Eye Donors by Jurisdiction, 213-21 213 21 21 3 1 1 21 222 23 12 11 11 2 99 9 9 11 1162 QLD NSW ACT VIC TAS SA WA AUS 1266 Figure 11.21 of Eye Donors by Donation Pathway, Australia, 21 1, 96 9 7 6 3 *Total Eye Donors in AUS during 21 = 1266 2 1 12 7 9 EyeOnly Eye+Tissue Eye+SolidOrgan Eye+Tissue+SolidOrgan 11 1

Figures 6.2 to 6.23 represent the number of donors for jurisdictions, in 21, by donor type. In 21 there were 96 eye only donors (Figure 11.22), 12 donors who donated eye and tissue (Figure 11.23), 7 donors who donated eye and one or more solid organs (Figure 11.2) and 9 donors who donated eye, tissue and one or more solid organs (Figure 11.2). Figure 11.22 Figure 11.23 of Eye Donors Only by Jurisdiction, 21 of Eye and Tissue Donors by Jurisdiction, 21 *Eye and Tissue Donors in AUS during 21 = 12 3 3 3 3 6 2 2 2 *Eye Only Donors in AUS during 21 = 96 3 33 36 1 1 1 7 7 2 33 1 QLD NSW ACT VIC TAS SA WA QLD NSW VIC WA Figure 11.2 Figure 11.2 of Eye and Solid Organ Donors by Jurisdiction, 21 of Eye,Tissue and Solid Organ Donors by Jurisdiction, 21 *Eye and Solid Organ Donors in AUS during 21 = 7 *Eye,Tissue and Solid Organ Donors in AUS during 21 = 9 3 3 3 3 29 29 3 2 2 1 1 2 2 1 26 1 7 1 2 QLD NSW ACT VIC TAS SA WA QLD NSW VIC TAS SA WA 11 1

Outcome of Eye Donation Eye banks contributed additional data elements to the national reporting in 21 by reporting corneal graft and sclera transplantation numbers across Australia. This further strengthened the collection and reporting of eye donation and outcomes and supplements reporting by EBAANZ and the Corneal Graft Registry (ACGR) reporting. Data was sourced from eye banks in Australia. For 21, there were 2,12 corneal transplants and 7 sclera transplants. Other outcome data, such as, follow up data, corneal grafts survival, trends in corneal transplant practice and comparisons between cornel graft procedures is reported by the ACGR. Considerable further information is available at https://www.flinders.edu.au/medicine/sites/ophthalmology/clinical/the-australian-corneal-graft-registry.cfm. Figure 11.26 shows the number of notified corneal transplants by jurisdiction for 21. Figure 11.26 of Corneas transplanted by Jurisdiction, 21 7 6 6 3 3 2 2 1 1 67 66 39 2 23 Total Corneas Transplanted, 21 = 212 191 1 QLD NSW ACT VIC TAS SA NT WA Figure 11.27 shows the number of notified sclera transplants by jurisdiction for 21. Figure 11.27 of Sclera Units transplanted by Jurisdiction, 21 2 21 Total Sclera Units Transplanted, 21 = 7 2 177 1 13 1 1 3 1 7 QLD NSW ACT VIC TAS SA NT WA 11 16

Suggested Cita on: ANZOD Registry, 216 Annual Report, Chapter 11: Tissue and Eye Dona on. Australia and New Zealand Organ Dona on Registry, Adelaide, Australia. 216. Available at: h p://www.anzdata.org.au Australia and New Zealand Organ Donation Registry c-\ South Australia Health and Medical Research Institute (SAHMRI) North Terrace, Adelaide South Australia Australia w: www.anzdata.org.au p: +61 12 7 216