Allograft surgery involves the transplantation of bone tissue from a donor, who is usually dead.
Currently, there is no national policy or guidance on obtaining informed consent for the use of allograft bone, particularly in relation to Māori.
According to the report, which has redacted the patient’s and surgeon’s details, the operation took place in July 2015 to repair injuries to the man’s wrist.
Three months later, during a post-surgery review, he was told he’d been given another person’s bone tissue.
The man told his surgeon that he was upset about the transplantation as it went against his cultural and religious beliefs, and he wished he’d been informed of it happening before surgery.
The report noted that the man did sign a surgical consent form, but this referred to a bone graft, not specifically an allograft, and did not mention that the bone tissue came from another person.
In response, the surgeon told the HDC it was his usual practice to discuss allografts. He explained that by doing so, it resulted in a better success rate and less trauma for the patient than using their own bone.
But, given the passage of time, the surgeon said he couldn’t recall what was discussed, and acknowledged that the information he provided to the patient was inadequate.
He also told the HDC that communication with the man was at times difficult and hampered by the man’s distress, trauma and chronic pain.
In her report, Deputy Commissioner Vanessa Caldwell said that while there may have been communication challenges between the two, it was up to the surgeon to ensure the patient received the necessary information to provide informed consent for the procedure.
Because this was not done, he had breached The Code of Health and Disability Services Consumer Rights (the Code), Caldwell found.
While she accepted that the surgeon didn’t know the patient’s ethnicity, she said the use of donor material has significant implications for people of different ethnicities, cultures and faiths – and it was important to acknowledge the cultural implications the inadequate information had on the patient, as a Māori man.
Deputy Commissioner Vanessa Caldwell investigated the patient’s complaint. Photo / James Gilberd Photography Ltd
“Adequate disclosure of the allograft process, specifically the bone tissue, was to be received from a deceased person, would have ensured sufficient time to undertake cultural processes which would make this an acceptable procedure to undergo and that current tikanga and kawa were engaged,” Caldwell found.
“Culturally safe care is fundamental to achieving positive health outcomes and experiences for whānau Māori.”
The report stated that the surgeon had now altered his practice so he was aware of the cultural and religious beliefs of his patients.
It recommended that the surgeon apologise to the man for the deficiencies identified in his care, and complete an audit on all allograft procedures he’d performed last year to determine the degree of compliance with adequate information provision, cultural safety considerations and consent procedures.
Caldwell said she also intended to engage in the development of a national informed consent policy by Health NZ, to ensure it included the appropriate written consent for the use of allograft bone.
Catherine Hutton is an Open Justice reporter, based in Wellington. She has worked as a journalist at the Waikato Times and RNZ. Most recently she was working as a media adviser at the Ministry of Justice.