How many wasted organs?
An Alarming Trend
An alarming trend toward living donors
When I read the following Washington Post editorial,
I was quite surprised at their statement that last year nearly half of all transplants
used organs from living donors. This came as a shock, as I'd thought cadaver organs were
far and away the norm. It turns out that the Post's figures were exaggerated, but
not grossly so. According to the figures on the website of the government-funded
group that tracks such statistics around the country, 39.4% of all kidney transplants
performed in the year 2000 utilized living donors. In 1996 the figure was 29%, so there is
a trend afoot.
Why do I say the trend is alarming? Given the abject failure of the
current altruistic system, doesn't this trend mean that more people are being saved?
Yes, and that's great. But it won't be long before someone dies trying to donate a
kidney or portion of their liver, and then we're going to have something to think about.
And, given that surgeons put the accidental death rate from such surgeries at 1% or so,
it's likely that some perfectly healthy people have already died while donating. Given
that cadaver donation is the only way to prevent surgeon's from violating their
Hippocratic Oath to do no harm (cutting into a healthy person is, to me, a clear violation
of that moral imperative), we should be doing all we can to bolster cadaver donation.
And as you know, that means allowing monetary incentives, and changing the current
federal law prohibiting it.
My second reason for considering this trend alarming is the potential
for black market activity, similar to what has been occurring in India, Brazil and other
countries for many years. Don't surgeons and hospital personnel have enough to do already,
without having to conduct lengthy interviews with prospective donor/recipient pairs, to
determine whether or not money is being passed under the table or not? We don't need
to have our hospital personnel doing the jobs of policemen, and we don't want to have
ill-conceived laws on the books that turn ordinary citizens into federal criminals. We
don't want to become a society where we're all spying on one another, and where we view
everyone as a potential enemy, to be feared. Hasn't our devastating "War on
Drugs" created enough misery already? Do we need to be encouraging more black
Washington Post editorial of July 9, 2001 - "The Wait for
The worsening shortage of organs for transplant is propelling the
field in some troubling directions. The most striking trend is the rise in organ donations
by living people--a phenomenon not confined, as in the past, to close relatives who donate
a genetically matched kidney, but widening to encompass swaps between families, donations
in return for a relative's favored treatment on waiting lists, donors sought through
classified ads and even, apparently, a thriving international black market. In the United
States, living donations jumped last year to nearly half the total, while donations from
people with brain death--long considered the preferable route--have stagnated.
Improved technology has made it safer than before to take
organs from living donors; for instance, a person can now donate part of a liver. But
living donations are no panacea. Even at best, living donations carry some health risk,
and allowing them to become the dominant option could create troubling pressure on
potential donors. A steady supply of organs from cadavers remains the route a responsible
society should favor.
Getting that supply up to the level needed, roughly triple the
current rate, will require sustained government attention. [Ugh!]
About half of all families approached after brain death is declared agree to donate their
relative's organs. But as many as two-thirds of such families are never approached. Tommy
Thompson, the secretary of health and human services, has urged states to add organ
donation to drivers' education curriculums and has proposed some other useful but modest
steps. International research suggests that far more aggressive initiatives are needed.
Spain, for instance, has a rate of cadaver donation about double the U.S. rate; there,
every hospital has its own team of transplant managers, doctors and nurses. They identify
and discreetly monitor likely donors [how'd you like to have these guys
hovering around you or your loved one?!] and, once brain death is declared,
take over management of the donation process.
Some argue such aggressive measures could lead patients and
relatives to fear that care will be compromised in an emergency. Any such system needs
safeguards--as U.S. hospitals now have--separating the determination of brain death from
the transplant decision. Inducements, too, need to be handled carefully--an intriguing
proposal by Rep. James V. Hansen (R-Utah) would give a $10,000 tax credit against the
estate of anyone whose family donates his or her organs. The main lesson from Spain
is that practical and systematic measures, not exhortation, are what alter donation rates.