Advance Care Directive Organ Donation Victoria

The Conflict Between End of Life Wishes and Organ Donation

Here's a scenario that catches many Victorian families by surprise: you've written a clear instructional directive refusing life-sustaining treatment, and you've also registered on the Australian Organ Donor Register. When you suffer a catastrophic brain injury, the treating team faces a direct conflict — your ACD says to withdraw treatment, but successful organ donation often requires temporary life support to preserve viable organs.

Without explicit instructions in your ACD, clinicians may withdraw treatment in accordance with your directive before the organ donation team can assess viability. Your registration on the donor register becomes meaningless.

How Victorian Law Handles Organ Donation in ACDs

The Medical Treatment Planning and Decisions Act 2016 allows you to include specific instructions about organ and tissue donation directly in your Advance Care Directive. This is more powerful than a standalone donor register entry because the ACD is a legally binding document that clinicians must follow.

You can address the donation conflict in two ways:

Consent to temporary life support for donation purposes. You can include an instructional directive that authorises short-term continuation of mechanical ventilation, circulatory support, or other interventions solely to facilitate organ and tissue retrieval — even if your general directive refuses ongoing life-sustaining treatment. This removes the ambiguity entirely: withdraw treatment, yes, but maintain organ viability first.

Decline organ and tissue donation. If you do not wish to donate, you can state that explicitly. This prevents any confusion if family members or clinical staff assume you'd want to donate.

Why the Donor Register Isn't Enough

Registering on the Australian Organ Donor Register is a valuable step, but it has practical limitations:

• It doesn't override your ACD. If your directive says to withdraw all life-sustaining treatment immediately, a donor register entry doesn't authorise the temporary continuation of support needed for donation.
• Family consent is still sought. In practice, Australian donation coordinators consult the family before proceeding with donation, even when the patient is a registered donor. If your family is unaware of your wishes or disagrees, the donation may not proceed.
• It doesn't specify clinical interventions. The donor register records your general willingness to donate. It doesn't address whether you consent to temporary ventilation, blood transfusions, or medication to preserve organ function after brain death has been determined.

What to Write in Your ACD

If you want to be an organ and tissue donor, consider including language along these lines in the instructional directive section of your ACD:

"I consent to the continuation of mechanical ventilation, circulatory support, and any other medical interventions required solely to facilitate organ and tissue donation, for a reasonable period following the clinical determination that I have no prospect of recovery. This consent applies even where my directive otherwise refuses life-sustaining treatment."

If you don't wish to donate, a simple statement is sufficient:

"I do not consent to organ or tissue donation under any circumstances."

Either way, the key is addressing it explicitly. Silence on the topic leaves the treating team guessing, and in a time-pressured clinical environment, uncertainty usually results in inaction.

Having the Conversation with Your MTDM and Family

Your Medical Treatment Decision Maker and immediate family need to know your donation wishes, because they'll be the ones a donation coordinator speaks with. If your MTDM doesn't know you've included a donation clause in your ACD, they may be caught off guard during an already overwhelming moment.

This conversation should cover:

• Whether you want to donate organs, tissues, or both
• Whether you're comfortable with temporary life support for donation purposes
• Any organs or tissues you specifically want to exclude (corneas, skin, bones)
• Whether you've registered on the Australian Organ Donor Register

The Bottom Line

The interaction between end of life directives and organ donation is a clinical and legal blind spot that most free government resources barely mention. If you want your donation wishes honoured, they need to be written into your ACD — not just ticked on a register.

The Victoria Advance Directive & Living Will Kit includes a dedicated organ donation section in the Treatment Decision Worksheet, with clinician-approved phrasing that aligns your donation wishes with your broader treatment refusals, so there's no ambiguity when the moment comes.

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