Why the transplant program will continue to run into overcrowding problems

A recent article in The Age  reported that the lung transplant  theatres at The Alfred Hospital had been closed for lack of funding. While there was some debate about whether this was necessary, the structure of the system suggests that the retrieval and transplant processes are coming under increasing pressure.

The  Federal Government has funded appointments of doctors to identify potential organ donors in hospitals. This policy has been particularly successful and donation rates have risen.This has combined with some significant improvements that  the coordinating body,DonateLife, has made to the system.

It is principle of systems theory that improving one part of the system  will place increasing stress on the unimproved  parts of the system. When this improvement, in this case increased funding  for the identification of donors, occurs at the beginning of the system,  the whole system comes under pressure.

The causal loop diagram below shows the dynamics of this process.

The improvements to the donation process and the increased funding increases the number of organ transplants and reduce the waiting list.

This creates pressure on the downstream donation and hospital processes which have not received the  increased funding of the  donor identification process.

There are some unintended consequences as well. Many organ donors require  a second  or possibly third transplant, so there is is delayed pressure on the system. In addition, improvements in medical technology  will lead to a broadening of the criteria for both  donors and and recipients. This serves to increase the waiting list. This means that the decrease in the waiting list as result of the increased funding may not be as great as was expected.

The main problem however remains the unequal distribution of funding across system. This, in addition to the  built-in dynamics of the system, means that situations such as the one that occurred at The Alfred will become more frequent.

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