August 30, 2014

Erin Currey

Staff Writer

Organ donations: not enough supply, too much demand

Published on December 14, 2011 in Opinion
by Erin Currey (Staff Writer)

There is a major supply-demand issue in organ donation. The demand is sky high, while supply is minimal at best. The U.S. does a decent job ensuring all those who can donate organs do, but the supply is still not high enough. There are huge amounts of waste in the current system of organ donation. The United States runs an opt-in system, meaning each individual must specifically state that they want to be an organ donor. In cases where a potential donor is unable to give consent (often because they are brain dead), the final decision falls to the living family, a legal situation which has resulted in messy lawsuits that split families apart. Wrapped within the scholarly jargon are questions about society, morality, and religion.        

In a podcast of Freakonomics Radio called “You say repugnant, I say… Let’s do it!” Stephen Dubner says, “It can be hard to find the border between what is repugnant and what’s not.” If you want people to donate more organs, why not let them sell parts of their kidney? We already let people sell their sperm or eggs, why not bring it one step further? He and his Freakonomics co-author, Steven Levitt, a research economist at the University of Chicago, highlight many issues of society which could be fixed or lessened in severity, but the methods are rejected on moral standings. They explore many different incentives to encourage people to donate organs. A “kidney exchange” was proposed and implemented in New England. If one needs a kidney, he finds a friend or relative willing to donate one. If those two are not compatible, however, the sick person is found another donor through the Kidney Exchange, while the original donor is matched up with a different sick person. Thus, for every kidney accepted by a patient, another organ is put into the system. But this only works with organs like kidneys, where one can donate them while still alive. The waiting list for organs is over 111,000 long.

Would you like to take that kind of chance with your life? I know I wouldn’t. We all have two kidneys, and most of us will never encounter kidney failure in our own body. We need to question whether or not we are willing to accept the system as it is, and run the risk of our own relatives dying for the lack of available organs. It’s a repugnant topic, and certainly one that’s hard to think about in high school. But in ten years, twenty years, our generation will be the one producing the politicians and doctors to whom these decisions are entrusted. Forty percent of Americans have signed up to be organ donors, but less than one percent of all Americans will die in a way that their organs may be harvested. That means the odds of someone who has consented to become a donor being able to donate is 0.4 percent. Meanwhile, 130 people join the National Transplant Waiting List every day.

So how does society make the numbers match up? Israel has a law called “Get Life, Give Life.” If someone has signed up to be an organ donor, he or she is given preference on the waiting list if they need an organ one day. If both a donor and a non-donor are compatible with the same heart, the donor takes preference. It’s simple, but it’s the first time in the world doctors have given out organs based on anything more than medical priority.

And how do hospitals manage the movement of organs? If a patient is considerate enough to die in a hospital in a way that allows their organs to be viable for transplant, the process is easy. However, any time brain death occurs outside a hospital where the doctors can sustain the organs, the organs begin to deteriorate on the spot, and minutes are of the essence. In Europe, there is a standard of presumed consent, where unless the patient or their family actively opts out, the process of organ donation begins from the instant you are pronounced brain dead. One imminent death has now turned into a situation where many lives can be saved. For this situation to work, there would be an Organ Preservation Unit that follows a traditional ambulance to the scene of an injury which might produce organs for transplant. If the patient dies, he or she is immediately transported from the ambulance to the Organ Unit, which begins the steps to prepare for transplant.

Some people worry this will shift the culture of emergency care, that doctors will begin to see severe head trauma cases as only organ transplants rather than an individual who needs to be saved. They worry that an EMT will not fully commit himself to resuscitating someone when he knows that there is an Organ Unit right around the corner.  I couldn’t disagree more. No doctor looks forward to having to tell a family about a death. There also wouldn’t be a conflict of interest: the doctors working with patients who need transplants are highly specialized because of the delicate nature of said procedures. These specialists do not determine the status of a patient’s life. The potential benefits of this system are too great to let our fears halt the policy from being put in place. Many Americans are signed up to be organ donors, and it’s our duty to ensure that their wishes are upheld. We must explore alternative methods of organ donation to salvage more viable body parts than we do in the current system, so that we can save as many lives as possible.