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September 24, 2007

Organ procurement in a world gone wild

Organs for transplantation are so scarce, and the imperatives for organ procurement are so compelling, that some folks seem to do the darnedest things (even if we leave recent and not-so-recent stories about China out of this discussion).

Consider the recent story of a transplant surgeon who allegedly put the interests of potential recipients above those of a potential donor and got socked with criminal charges in California as a result -- a striking story and the impetus for my writing about organ transplantation today.

There are clearly points of tension between donor and donee, e.g., choosing a "good death" unattended by tubes and machines vs. going all-out to preserve organs for transplant. Patient self-determination butts heads with the so-called Breakthrough Collaborative, which has, for the past several years, sought to increase the "conversion rate" (i.e., rate of organ donation by eligible donors).

New federal regulations governing transplant centers don't really address procurement efforts, and state laws are being revised to allow for more organ donations, by potentially impinging on donors' wishes for a good death in order to preserve donated organs.

The demand for organs has always outpaced supply in this country (OPTN figues show a US organ transplant waiting list of about 98,000 at the moment), and these recent developments are just some of the ways folks are trying to deal with this. For further background, there is an interesting Joint Commission white paper on organ donation, a few years old but worth a read.

Another sort of approach, which I would personally like to see explored more fully in this country, would be adoption of a "soft" presumed consent law -- a reversal of the current legal presumption regarding consent to organ donation, but with appropriate protections allowing individuals and family members to opt out. For background on this approach, see the British Medical Asscociation's recommendation regarding presumed consent.

It seems to me that we've been waiting for science fiction solutions -- like artificial hearts (though Jarvik is now hawking Lipitor) and xenografts -- to become mainstream, instead of dealing with this issue head-on.

-- David Harlow

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Your story about __ highlighted the tragic shortage of human organs for transplant operations.

Over half of the 97,000 Americans on the national transplant waiting list will die before they get a transplant. Most of these deaths are needless. Americans bury or cremate about 20,000 transplantable organs every year. Over 6,000 of our neighbors suffer and die needlessly every year as a result.

There is a simple way to put a big dent in the organ shortage -- give organs first to people who have agreed to donate their own organs when they die.

Giving organs first to organ donors will convince more people to register as organ donors. It will also make the organ allocation system fairer. People who aren't willing to share the gift of life should go to the back of the waiting list as long as there is a shortage of organs.

Anyone who wants to donate their organs to others who have agreed to donate theirs can join LifeSharers. LifeSharers is a non-profit network of organ donors who agree to offer their organs first to other organ donors when they die. Membership is free at www.lifesharers.org or by calling 1-888-ORGAN88. There is no age limit, parents can enroll their minor children, and no one is excluded due to any pre-existing medical condition.

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