The number of people waiting for a transplant far outweighs the number of organ donors in Australia. The Northern Territory (NT) of Australia has the highest incidence of end-stage kidney disease (ESKD) in Australia. A large proportion of those with ESKD are First Nations Australians that require renal dialysis and who are more likely to require and benefit from a renal transplant. In 2018, 53% (21/40) of potential organ donors referred to DonateLife NT identified as First Nations Australian; one of these went on to become an organ donor.

DonateLife NT coordinates all organ donation activities across the NT and is responsible for increasing community awareness, promoting the importance of organ donation, and discussing willingness to be an organ donor with families. During these activities with First Nations Australians, a variety of views that influence thoughts and decision making about organ donation have become very apparent. To explore this further, a literature review was undertaken to determine the views on organ donation among First Nations People and consider how this compared to the anecdotal experience of DonateLife NT.

Findings from the literature review are consistent with the experience of DonateLife NT. To optimise dialogue about organ donation with First Nations People, it must be conducted in a respectful and culturally appropriate way. This serves to empower through enhancing knowledge and understanding and enables the ability to make informed decisions.

Further qualitative research is recommended to increase understanding of the views of First Nations Australians about organ donation and ultimately ensure that donation discussions are appropriately informed, culturally secure, and form part of quality end of life care in hospital settings.

Forewarned by the early COVID-19 experience elsewhere, and the need to create a COVID-safe environment for lung transplantation (LTx) patients and their attendant healthcare workers (HCW), the Lung Transplant Service at The Alfred Hospital in Melbourne radically re-structured its ambulatory out-patient model to an entirely home-based Telehealth service that involved the majority of the LTx staff also working from home.

The hospital’s LTx service manages over 800 post-LTx patients. The hospital’s Telehealth portal was used for patient consults, and daily clinics were established. Administrative, nursing, allied health and physician staff were provided with computers at home, as well as remote access to the hospital’s electronic medical record. The in-patient LTx team were available for critical in-person assessments, specifically for patients early post-LTx. The LTx service remained operational despite two COVID-19 waves in 2020 and 73 LTx and one heart–LTx, a 20% decline from usual baseline. The LTx team have remotely provided over 175 medical and allied health reviews per week. Over 20,000 separate LTx drugs were posted out, providing uninterrupted access to LTx-critical medications. Access to spirometry and bronchoscopy remains suboptimal. Despite widespread community transmission, there was no COVID-19 infection in the LTx team, and only a single episode of self-limiting community-acquired COVID-19 infection in the wider LTx patient population.

Reflecting the need to also provide a COVID-safe environment for HCW, the service established a completely remote ambulatory service that maintained both LTx patients and LTx HCW at home. Whilst COVID-19 infections have been avoided, future studies will need to assess whether remote access to LTx has impacted on non-COVID morbidity and mortality in our LTx population.