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25 The Organ Donor Shortage




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This article is from the Organ Transplant FAQ, by mike_holloway@hotmail.com (Michael Holloway) with numerous contributions by others.

25 The Organ Donor Shortage


UNOS statistics reveal that in 1993, on average, 8 people a day died in
the US while on the waiting list. As organ transplantation has passed
out of the experimental stage, the number of people with end stage
diseases seeking a transplant has slowly but steadily increased. The
number of donations however, has not increased. Sadly, this is not
because there are not more potential donors. Various estimates are that
anywhere from 60 to 70% of potential donations are either refused by the
next-of-kin or are never requested. These estimates take into account
the criteria for brain-dead, heart-beating donors and other
contraindications. Roughly half of the missed donations appear to result
from failure of physicians to either declare brain death in a timely
manner, or their failure to notify their Organ Procurement Organization
of potential donors. This is despite enactment in all 50 states of
"required request" legislation that mandates that all potential donations
be sought. Apparently, there is no enforcement of these laws.

There are a variety of proposals to increase the number of
donations. For example: public and professional education, giving
people who have registered their support for donation additional
points on the waiting list should they ever need a transplant
themselves (preferred status), changing the structure of donation
from a required opting-in to a required opting-out strategy
(presumed consent), and requiring all adults to register their
choice of whether they would permit donation in the event of their
death (mandated choice or required response).

There are also, on occasion, issues raised in the media that might
be of interest to medical ethicists, but which would have little to
no positive impact on the number of organs available for
transplantation. Organ donation from anencephalic infants and
executed convicts, for example, are issues that could possibly
distract attention from the more important issue of obtaining wide
spread support for donation.

In the 1994 September 14th issue of JAMA, the AMA has finally (after
nearly a year of delay after the policy's adoption) made public its
recommendation that states enact into law a mandated choice policy.
The length of time it has taken to make this policy public indicates
the medical community's inability to appreciate that this is a
crisis situation for those patients on the waiting list whose lives
could potentially be saved. It also indicates that there are
individuals who do recognize the seriousness of the situation and
are working to move their colleagues toward a feasible solution.

References:

Siminoff LA, Arnold RM, Caplan AL, Virnig BA, Seltzer DL
Public Policy Governing Organ and Tissue Procurement in the United
States, Results from the National Organ and Tissue Procurement Study
Ann. Intern. Med. 1995 July 1;123:10-17
Note: Some of the conclusions in this study are at odds with those of
studies conducted by The Partnership for Organ Donation.

Council on Ethical and Judicial Affairs, American Medical Association
Strategies for Cadaveric Organ Procurement.
JAMA 1994 Sept.14;272(10):809-12

Murray TH, Youngner SJ
Organ Salvage Policies, A Need for Better Data and More Insightful
Ethics. (editorial)
JAMA 1994 Sept.14;272(10):814-5

Wolf JS
The role of the United Network for Organ Sharing and designated
organ procurement organizations in organ retrieval for transplantation.
Arch Pathol Lab Med 1991 Mar;115(3):246-9

Prottas J Batten HL
Health professionals and hospital administrators in organ
procurement: attitudes, reservations, and their resolutions.
Am J Public Health 1988 Jun;78(6):642-5

Annas GJ
The paradoxes of organ transplantation [editorial]
Am J Public Health 1988 Jun;78(6):621-2

Evans RW Orians CE Ascher NL
The potential supply of organ donors. An assessment of the efficacy
of organ procurement efforts in the United States.
JAMA 1992 Jan 8;267(2):239-46

Spital A
Mandated choice. The preferred solution to the organ shortage?
Arch Intern Med 1992 Dec;152(12):2421-4
Mandated Choice for Organ Donation: Time To Give It a Try
MD Annals of Internal Medicine, 1 July 1996. 125:66-69.
http://www.acponline.org/journals/annals/01jul96/inbalan1.htm

Gnant, M.R.X., et al.,
The impact of the presumed consent law and a decentralized organ
procurement system on organ donation: quadruplication in the number
of organ donors. (1991) Transplantation Proceedings, 23(5):2685-2686.

Michielson, P.
Organ shortage-What to do? [Presumed consent in Belgium] (1992)
Transplantation Proceedings, 24(6):2391-2392.

Kott, Andrea., Organ Procurement Programs in State of Emergency.
Medical World News Feb 1992, v33n2, p. 15-16

Lee, P.P., Kissner, P., Organ donation and the Uniform Anatomical
Gift Act. (1986) Surgery 100:867-875.

"Solving the Organ Donor Shortage", The Partnership for Organ Donation,
Inc. (617)482-5746.

UNOS Ethics Committee Reports on alternatives for organ donation:
"Financial Incentives for Organ Donation"
"Preferred Status for Organ Donors"
"An Evaluation of the Ethics of Presumed Consent and a Proposal Based on
Required Response"
- available from UNOS (804)330-8500
- also available through the Yale biomedical gopher (see section II)

Gallup Poll on Attitudes Towards Organ Donation, available in the Yale
biomedical gopher and Transweb (see section II), and from The Partnership
for Organ Donation, Inc. (617)482-5746.

 

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