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How many wasted organs?
An Alarming Trend
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How many potential cadaveric donors are there?
Answer #1: two to three times as many as actually donate
The Center for Organ Recovery and Education's website says between 10,000 and 12,000
Americans die each year who would be good donors, of whom only 5,200 actually donate - a
roughly 50% donation rate. (Generally, to be a good donor candidate, one must die under
conditions where one suffers brain death, while one's other vital organs are in good
shape, and can be kept that way until surgical removal.) A January
23, 2000 San Diego Union-Tribune article stated that 1,500 Californians die of brain
death each year, but only 500 donate - a 33% donation rate,
but a much smaller sample size. In 1983, in a U.S. House of Representatives hearing
on the matter, Al Gore stated that 2,500 donated out of the 20,000 who suffered brain
death, for a 12.5% donation rate. A check of a website devoted to the subject of
brain death gave a figure of 10,000, so it seems politicians may exaggerate (golly
gee!). I can't fault Mr. Gore on that one, though, because I apparently got a
similar figure (~20,000 a year wasted potential organ donors) prior to writing a letter to the editor on the subject in 1993. A 1997 New York Review article by David Rothman states that "One
recent study found that when families were asked by hospitals for permission to take an
organ from a deceased relative, 53 percent flatly refused." And, not all who
could donate are asked. A July 9, 2001 Washington Post editorial stated that up to 2/3 of
potential donors aren't asked. Taking all of the above into consideration, it seems
reasonable to conclude that no more than 50% of potential donors donate (using the rosy
CORE figures), and the figure could be as low as 17% (if only one-third are asked, of whom
half donate).
Answer #2: more than enough
Even if the potential supply of cadaveric organs is only twice the current level, there's
good evidence that it'd be adequate to meet the demand.
The evidence for this is found in Belgium's experience. Ever since they instituted a
national policy of presumed consent (where one has to go down to city hall and
sign papers stating that one does NOT wish to be an organ donor, whereupon one's name is
placed on a computerized national registry), they have had a surplus of organs, such that
they attract foreigners to come and have their transplants done in Belgium. Of course,
that is not a policy any proud, freedom-loving people would accept. But, it does
show that the demand COULD be met without resort to living donors.
Answer #3 more than more than enough
Undoubtedly, as surgical procedures and medicine in general advance, more and more use
could be made of transplantable organs. In the very long run, we'll
probably develop the technology to grow replacement organs from a person's own stem cells,
rendering the issue mostly moot. But in the near term, to increase the organ supply
dramatically, I wonder if ethical and practical steps could be taken to expand the donor
group beyond the brain death category. Could hospitalized patients, dying of
maladies other than those leading to brain death, be placed on or near life support in
such a way as to preserve at least some of their organs for transplantation
purposes after their death? The answer seems to be "yes": [from that
same, brain death website: "The
number of people with brain death and PVS [progressive vegetative state] will
expand from the current 10,000, at any one time in the United States, to many times that
number as technology is increasingly successful at keeping them alive. The number with
dementia so severe that they are functionally equivalent to PVS may reach the
hundreds of thousands."
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